WARRANTY REGISTRATION INFORMATION


Machine Location

Company Name:
Country:
Company Address:
Company City:
State or Province:
Zip or Postal Code:
Date Purchased:
<December 2017>
SunMonTueWedThuFriSat
262728293012
3456789
10111213141516
17181920212223
24252627282930
31123456
Date Installed:
<December 2017>
SunMonTueWedThuFriSat
262728293012
3456789
10111213141516
17181920212223
24252627282930
31123456
Model Number:
Serial Number:
Purchased From:

Manager Responsible for Maintenance of Machine:
Name :
Job Title:
Manager City:
Manager Country:
Machine Location::
Manager City:
Manager State/Province:
Manager Zip/Postal Code:
Phone Number:
Fax Number:
Email Address:  

Customer Status :
Size of Facility :
Primary Floor Type :
Application :
Industry Classification of Facility :
Equipment Purchased by a Contract Cleaner :
Inventory Type :
Have you purchased Qleeno Solution for your Machine? :

Is this the first Qleeno Product you have Purchased? :
Why did you choose a Qleeno Product? :
Please give us your Comments: :
How did you Learn about Qleeno Products? :