MEDRAD Warranty Registration

Please enter the information below to register your warranty on your MEDRAD equipment.

All fields are required for registration.

Contact

Hospital/Clinic:

Contact Name:

Street Address:

City:

State/Province:

Country:

Zip/Postal Code:

Telephone:

Installation

Company Responsible
for Install:

Name of Installer:

Installation Date / /

Imaging Equipment
Manufacturer:

Product

Select Product/System:

System Serial Number:

Where is my serial number located? >>

Did your system arrive in good condition? Yes No

Did you have any problems with the system during installation? Yes No

Please contact me about MEDRAD's Extended Warranty Coverage. Yes

Please contact me about System Operational Training. Yes

If you would like to be contacted by E-mail, please include an E-mail address.

Other Comments:

Contact
Hospital/Clinic:
Contact Name:
Street Address:
City:
State/Province:
Country:
Zip/Postal Code:
Telephone:
Installation
Company Responsible for Install:
Name of Installer:
Installation Date	/ /
Imaging Equipment Manufacturer:
Product
Select Product/System:
System Serial Number:

Did your system arrive in good condition?	Yes	No
Did you have any problems with the system during installation?	Yes	No
Please contact me about MEDRAD's Extended Warranty Coverage.	Yes
Please contact me about System Operational Training.	Yes
If you would like to be contacted by E-mail, please include an E-mail address.