Martin Innovations
5
1 Product Registration Form
Register online at
www.MartinInnovations.com/prodreg
Or
Complete this form and mail or fax to:
Martin Innovations
2555 Wendell Blvd
Wendell, North Carolina 27591
Fax Number: (919) 829-8045
Name:___________________________________________________________
Address:_________________________________________________________
City:__________________________________________________ State:_____
Zip/Postal Code:____________________
Email:_______________________________________ Phone: (___) ___ - ____
Martin Innovations Model # _______________________________________________________
Martin Innovations Serial # _______________________________________________________
(See page 28 for the location of these numbers.)
Purchased From: _______________________________________________________________
Address: ________________________________________________________________
City:_________________________________________________ State:_____
Zip/Postal Code:___________________
Date of purchase: ________/________/_________
Product purchased for: Hospital
Clinic
Private Practice
Home Use
Other
I purchased this product because: (list important features)
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
Who referred you to Martin Innovations?
Would you like to participate in Customer surveys from Martin Innovations?
Would you like additional information about products from Martin Innovations?
If yes, what particular medical condition(s) would you like assistance with?__________________
________________________________________________________________
What additional information would you like to see on the Martin Innovations web site?
________________________________________________________________
