United States [change]
Document Imaging Products
Warranty/Product Registration (Hardware/Equipment)


Please provide the following information.

* - required fields

PRODUCT PURCHASE INFORMATION
 
*Product:  
*Product Serial Number:   
Kodak K Number:   
 Sample K# label
*Purchased Date:         
 
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.)