Complete form to activate your Dukane AV Warranty

*Required Fields

Customer Information
Salutation:	SelectMrMsMissMrs
*Name: (First)		(Last):
Title:
*Organization:
*Street:
*City:
*State:
*Zip:
Phone:	Ext:	Fax:
*Email:
Decision Maker of AV purchases:
Name:		Title:
Product Information
*Model:		You may enter multiple warranties (up to 15) on one page as long as they are the same model number.
*Serial:		Separate serial number entries with a comma.
*Date Purchased:
Miscellaneous Information
Organization Type:		Other:
Make a selectionEducation, Grades K-8Education, High SchoolCollege/UniversityVocational/Technical SchoolLibrary/Information CenterManufacturingRetail/WholesaleLegalConsulting FirmReal EstateGovernmentReligiousHealth Care
Primary Use of Product:		Other:
Make a selectionComputer TrainingClassroom InstructionSales PresentationBusiness Training
Type of Product Purchased:		Other:
Make a selectionLCD ProjectorOHP ProjectorFilmstrip
Where was the Product purchased:		Other
Make a selectionInternetAV DealerCatalogOffice Supply Store
Do you Travel with this product:		Yes      No
How did you first learn of the Product:		Make a selectionInternetAV DealerCatalogDemonstrationOffice Supply DealerTrade ShowRecommendationEditorial ReviewAdvertisement
What is the number one reason you chose Dukane presentation products:		Other
Make a selectionPriceSize/WeightFeatures
What Dukane Products have you purchased in the past:
Comments: