WARRANTY REGISTRATION

Warranty and Replacement Bulb Registration
first name:
last name:
middle initial:
street:
city:
state:
zip:
phone:	( ) -
e-mail:
upc code (found on box):
where purchased?:
date of purchase:	/ /

how did hear of product:
does anyone in your family have allergies?:	yes
Which of the following would influence your decision to purchase air health?: (select all that apply)	Allergies Asthma Mold Odor Air Quality Reduce airborne germs and bacteria
How old is your home?: (years)	0-10 11-20 21-30 31+
place me on mailing list:	yes
By submitting this form you are registering your product for warranty and an e-mail reminder that will be sent to you approximately 10 months from the date of registration. You will then be given instructions on how to obtain your replacement bulb at the discounted price. Thank you for registering.