Wallace International Kinetic DC 15W Installation And Maintenance Manual page 5

PRODUCT & WARRANTY REGISTRATION
Enter the following information to register your Wallace product. Please write legibly.
NOTE: To extend the operator warranty beyond 1 year, you must return this registration within 60 days of purchase. Refer to the Limited Warranty.
Installer Information
First/Last Name: _________________________________________
Company Name: _________________________________________
Address: _______________________________________________
City: ____________________________ State/Province: __________
Country: _______________________
Daytime Phone: ___________________ Fax: __________________
E-mail: _________________________________________________
End-user Information
First/Last Name: _________________________________________
Company/Association: ____________________________________
Address: _______________________________________________
City: ____________________________ State/Province: __________
Country: _______________________
Daytime Phone: ___________________ Fax: __________________
E-mail: _________________________________________________
Did you visit the Wallace International website before purchasing your product?
Yes No
How did you hear about Wallace gate operators? (Check all that apply.)
Advertisement Exhibition
Business associate Other (please specify):
What factor(s) most influenced your purchase? (Check all that apply.)
Performance Price
Reliability Brand
Recommendation Warranty
Fax or Mail this completed form to:
Wallace International
90 Lowson Crescent
Winnipeg, MB, CANADA R3P 2H8
For technical support call: 866-300-1110
Wallace International does not share this warranty registration information with third parties unless the requested services, transactions, or legal requirements necessitate it.
© 2010
Zip/Postal Code: _________
Zip/Postal Code: _________
Distributor
____________________________________
Power
Prior Experience
Product Weight
Fax: 204-284-1868
Email: wallaceintl.com
Today's Date:_____________________
Product Information
Model name/number: ______________________________________
Serial number: ___________________________________________
Purchase Date: __________________________________________
Purchase Price: __________________________________________
Distributor's name: _______________________________________
Distributor's City: ________________________________________
Country: ________________________________________________
Installation Date: _________________________________________
Who is completing this form?
Installer End User
Maintenance Personnel
Additional Comments
_______________________________________________________
_______________________________________________________
Trade Show
Distributor
Other ___________________
D0394 Rev. B