Equipment Warranty Registration Form ( 785_DISPENSING_VALVE )

Tridak warrants all dispensing and filling equipment parts and labor for a period of three years from the date of shipment. This warranty is exclusive of existing manufacturer warrantees or components considered disposable. Tridak's liability is specifically limited to the repair or replacement of defective components or correction of faulty workmanship. This warranty is in effect only if the machine is used for the purpose defined in this quotation.

Please complete the form below to register for the equipment warranty. Please be sure to provide all necessary information. Fields marked with an (*) are required.

*Prefix:	Please Select Mr. Miss. Mrs. Ms.
*First Name:
*Last Name:
*Title:
*Company:
*Address:
*City:
*State/Province:	Please Select Not Applicable Alabama Alaska Alberta Arizona Arkansas British Columbia California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Labrador Louisiana Maine Manitoba Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Brunswick New Hampshire New Jersey New Mexico New York Newfoundland North Carolina North Dakota Northwest Territories Nova Scotia Ohio Oklahoma Ontario Oregon Pennsylvania Prince Edward Isle Puerto Rico Quebec Rhode Island Saskatchewan South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Virgin Islands Washington West Virginia Wisconsin Wyoming Yukon Territory
*Postal Code:
Country:
*Phone:
Fax:
*Email:
*Equipment Model Number:
*Serial Number:
*Date of Purchase:
*Purchased From:
*Equipment Will Be Used For:
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