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Warranty Registration Form

Buyer Information

Salutation *

Gender *

First Name *

Last Name *

Email *

Confirm Email *

Address *
Street Address

Address Line 2

City

State / Province / Region

ZIP / Postal Code

Country

Primary Phone *

Alternate Phone

Purchase Information

Device Model *

Device Serial No *

(Can be found on the rear of the laser device, under the sports cap)

Date of Purchase *

Purchase Amount *

Don't use a comma to separate thousands.

Purchased through? *

Order No. *

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