Laser Registration
Please fill the form completely to ensure that if you ever need a repair that you receive the full warranty benefits. Please keep your invoice as a copy may be requested to confirm purchase date.
First Name
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Last Name
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Practice Name
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Address
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Address 2
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City
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State
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Zip Code
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Practice Phone Number
Please enter number using this format (ex. 000-111-2222)
Your answer
Laser Purchased
Purchase Date
MM
/
DD
/
YYYY
Serial Number
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Email
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