Warranty Card – LS

 

Required Details

Your Name:

Your Email:

Phone Number (required)

Street Address:

City:

State:

Zip Code:

Country:

Product Name:

Serial #:
[text* Serial#]

Purchase Date:

Dealer Name:

Dealer Address:

 

Demographics (Optional but appreciated!)

Purchased For:

Reason you purchased:

Gender:

Age:

-50---65---80---95--

Housing:

Is the User Living Alone?

Would you recommend this product to others?

Additional Comments?

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