This form assigns which computer and peripherals are assigned to the On Site Warranty.
Please provide the following contact information:
Enter the date of ... :
-- mm/dd/yy
First Name Last Name Title Organization Street Address Address (cont.) City State/Province Zip/Postal Code Country Work Phone Home Phone FAX E-mail
Please provide the following product information:
Product Name Product 1 Product 2 Product 3 ... Product N Model Version Number Operating System Serial Number
Select any seven peripherals to be included in the warranty:
Monitor Printer Keyboard Mouse Scanner USB Hub MP3 Player External Drive PDA