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Product Warranty Activation Form

 

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Date: *
 Distributor Name: *

Product:
Model #: *
Serial #: *
Date Installed: *
Installer:
 

Customer Name: *
Facility: *
 
Address: *
Country: *
City: *
 Postal Code: *
Telephone:
 Email: *
 Fax:

Contact Name: *
Title:

THANK YOU FOR CHOOSING BIODEX!
Please state your reason(s) for selecting Biodex:
Features   Quality   User Friendly   Price   Dealer   Existing Biodex Owner
Other:
What other products were considered?:
Additional Comments:

FEEDBACK
What prompted your interest in this product?

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Other:



 
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Biodex Medical Systems, 20 Ramsay Road, Shirley, New York, 11967-4704
Tel: 800-224-6339 (Int’l. call 631-924-9000), Fax: 631-924-8355, Email: info@biodex.com
Biodex™ is a registered trademark of Biodex Medical Systems, Inc.
© Copyright Biodex Medical Systems, Inc. 2008