Installer: Please complete the following information
Dealer Name & Address: ________________________________________
_____________________________________________________________
Installer: _____________________________________________________
Phone #: _____________________________________________________
Date Installed: ________________________________________________
Serial #: ______________________________________________________
Regency®, Bellavista®, Surefire™, and AstroCap™ are trademarks of FPI Fireplace Products International Ltd.
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Bellavista
B36XTCE
Printed in Canada