Dentalaire Warranty Registration

* All fields are required

Facility Name

Contact Name

Street Address

City

State
---AKAZARCACOCTDEFLGAHIIDILINIAKSKYLAMEMDMAMIMNMSMOMTNENVNHNJNMNYNCNDOHOKORPARISCSDTNTXUTVTVAWAWVWIWY

Zip Code

Telephone

Email Address

Model Purchased (Item 1)
Please SelectAir Compressed High Speed Dental StationCorix X-Ray GeneratorDTX Digital Dental Imaging SystemOther

Serial Number

Model Purchased (Item 2)
Please SelectAir Compressed High Speed Dental StationCorix X-Ray GeneratorDTX Digital Dental Imaging SystemOther

Serial Number

Model Purchased (Item 3)
Please SelectAir Compressed High Speed Dental StationCorix X-Ray GeneratorDTX Digital Dental Imaging SystemOther

Serial Number

Model Purchased (Item 4)
Please SelectAir Compressed High Speed Dental StationCorix X-Ray GeneratorDTX Digital Dental Imaging SystemOther

Serial Number

Note: If you are registering more than 4 items, please submit this form, refresh, and complete another form.

Date Purchased

Distributor purchased from
---Henry Schein Animal HealthMidwest Veterinary SupplyMWI Veterinary SupplyAnimal Health InternationalVictor Medical CompanyPatterson Veterinary SupplyWestern Medical Supply, Inc.Miller Veterinary Supply Co., Inc.Veterinary Anesthesia SystemsVeterinary Dental Supplies

Upload invoice here