Dentalaire Warranty Registration

* All fields are required

Facility Name

Contact Name

Street Address

City

State

—Please choose an option—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

—Please choose an option—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

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