Purchase Information
Write in the model and serial numbers below for all applicable equipment such as the chair, unit light and
unit control head.
MODEL: _______________________________
SERIAL NUMBER: ______________________
MODEL: _______________________________
SERIAL NUMBER: ______________________
MODEL: _______________________________
SERIAL NUMBER: ______________________
Notes / Service History
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DATE PURCHASED: _____________________
DATE INSTALLED: ______________________
DEALER NAME AND ADDRESS:
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31064 R00
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