© 2010
D0394 Rev. B
PRODUCT & WARRANTY REGISTRATION
Enter the following information to register your Wallace product. Please write legibly.
Today’s Date:
_____________________
NOTE:
To extend the operator warranty beyond 1 year, you must return this registration within 60 days of purchase. Refer to the
Limited Warranty
.
Installer Information
First/Last Name: _________________________________________
Company Name: _________________________________________
Address: _______________________________________________
City: ____________________________ State/Province: __________
Country: _______________________ Zip/Postal Code: _________
Daytime Phone: ___________________ Fax: __________________
E-mail: _________________________________________________
End-user Information
First/Last Name: _________________________________________
Company/Association: ____________________________________
Address: _______________________________________________
City: ____________________________ State/Province: __________
Country: _______________________ Zip/Postal Code: _________
Daytime Phone: ___________________ Fax: __________________
E-mail: _________________________________________________
Product Information
Model name/number: ______________________________________
Serial number: ___________________________________________
Purchase Date: __________________________________________
Purchase Price: __________________________________________
Distributor’s name: _______________________________________
Distributor’s City: ________________________________________
Country: ________________________________________________
Installation Date: _________________________________________
Who is completing this form?
Installer
End User
Distributor
Maintenance Personnel
Other ___________________
Additional Comments
_______________________________________________________
_______________________________________________________
Did you visit the Wallace International website before purchasing your product?
Yes
No
How did you hear about Wallace gate operators? (Check all that apply.)
Advertisement
Exhibition
Distributor
Trade Show
Business associate
Other (please specify): ____________________________________
What factor(s) most influenced your purchase? (Check all that apply.)
Performance
Price
Power
Reliability
Brand
Prior Experience
Recommendation
Warranty
Product Weight
Fax or Mail this completed form to:
Wallace International
Fax:
204-284-1868
90 Lowson Crescent
Email:
wallaceintl.com
Winnipeg, MB, CANADA R3P 2H8
For technical support call: 866-300-1110
Wallace International does not share this warranty registration information with third parties unless the requested services, transactions, or legal requirements necessitate it.
