Warranty return form – Advanced Global Technology AGT HD Pulse HDT200 User Manual

Page 34

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Warranty Return Form

33

Cut Along the Dotted Line

Personal Information

Full Name:

______________________________________________________

Address:

______________________________________________________

______________________________________________________

Home Phone:

(____)______________ Alternate Phone: (____)______________

Email Address: ______________________________________________________

Product Information

Model Number ____________________

Serial Number ___________________

Date of Purchase __________________

Where Purchased ________________

Brief Description for why Product is being Returned:_________________________

___________________________________________________________________

___________________________________________________________________

Last

First

M.I.

Street Address

Apartment/Unit #

City

State

Zip Code

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