Kodak Document Imaging

Document Imaging Products
Registration for Enhanced, Extended, Post Warranty and Support Services Care Kits

Please provide the following information as completely as you can. After you have finished, a confirmation page will be available for you to print for your records.

* - required fields

CARE KIT PURCHASE INFORMATION


	Care Kit Terms & Conditions
*KODAK Care Kit purchased:
*KODAK Care Kit Serial Number:
	(located within the virtual Care Kit pdf file)
Care Kit Purchase Date:

PRODUCT PURCHASE INFORMATION

*Product:
*Product Serial Number:
	* The 'Product Serial Number' field is required for Extended Warranty and POST Warranty Care Kits.
Kodak K Number:
	Sample K# label
Purchased Date:
	* The 'Purchased Date' field is required for Extended Warranty Care Kits.


INSTALLED AT LOCATION

*Full Name:
Job Title:
*Company Name:
*Address 1:
Address 2:
*City:
*State / Province:
*Zip / Postal Code:
*Country:
E-mail:
*Phone:
Fax:

Please send me promotional e-mails from KODAK Document Products and Services.
	Yes No


SALES INFORMATION

Reseller Purchased From:
Reseller Full Name:
Reseller City:
Reseller State / Province:
Reseller Zip/Postal Code:
Reseller Email:
Reseller Phone:
Distributor Email:

BILLING INFORMATION

	Check box if same as Installed at Location above, otherwise please input the following information:
Full Name:
Job Title:
Company Name:
Address 1:
Address 2:
City:
State / Province:
Zip / Postal Code:
Country:
E-mail:
Phone:
Fax:

ADDITIONAL INFORMATION

Additional Comments:

Promotion Code:
	(Original Promotion Code must represent your actual purchase. Offer void where prohibited by law. Resellers of KODAK Products are excluded. Registering entitles you to receive the promotion stated. If a rebate check is involved, all obligation of Kodak will be discharged by issuing the check and mailing it to the address given by you. Kodak is not responsible for mail that is lost, mutilated or delayed. Please allow 60 days for delivery.)