Warranty

Serial Number(Required)

Model Number(Required)

Name of Owner(Required)

First Last

Company Name

Please include the company name if a business purchase

Address(Required)

Street Address City State / Province / Region ZIP / Postal Code Country

Name of Dealer Purchased From(Required)

Installation Date:(Required)

Type of Gas:(Required)

Natural Gas

Propane Gas (LP Gas)

The Type of Place Purchased From:(Required)

How did you first become aware of this product?(Required)

What were the two most important factors influencing your purchase?(Required)

What other factors influenced your decision to purchase?

Please indicate your age category

Under 25 years

25 through 49 years

50 through 64 years

65 years or older

Installed by:

Myself, Family Member, Relative

A Friend, Neighbor or Other Individual Who Did Not Charge for Installation

The Place Where It Was Purchased

A Professional, Other Than The Seller, Who Charged for Installation

Other

Name of Professional Installer:

Other Installer:

Where Installed

Primary Residence

Second Secondary (Cottage, Vacation Home)

Other

Type of Primary Residence

Single Family Home

Apartment/Condo/Duplex/Townhouse

Mobile/Manufactured Home

Other Place of Installation

Room Installed

Other Room Where Installed:

Unique ID

Answer to Submit 5+5=(Required)

Warranty Registration