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First Name
Last Name
Address: (Physical Address Where Unit Is Located)
City
State/Province
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
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Idaho
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Texas
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West Virginia
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British Columbia
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Newfoundland and Labrador
Northwest Territories
Nova Scotia
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon
None of the above
Zip/Postal Code:
Email
Product Type
Criterion
Easy Home
Ewave
Kitchen Living
Magic Chef
Magic Chef Commercial
Norpole
Oster
Sunbeam
Vissani
Other
Model Number
Serial Number
Date of Purchase
Purchase From
Aldi
Amazon
American Hotel
Ammar’s
Authorized Dealer
BiMart
Buy.com
Compact Appliance
Cook Brothers
Costco
Dealer
Do it Best
EdgeStar.com
Elite Creations (BI)
Elite Deals
Fingerhut
Fleet Mart
Fred’s
Golden Opportunity
Grainger
Han’s Appliance
HD Supply
Home Depot
Home Depot Repair
HomeDepot.com
HotWaterSource.com
IceMakerDirect.com
JC Penny
Kegerator.com
Kohl’s
Living Direct
Mason
Meijer
Menards
Mills
Navy Exchange
Norpole Dealer
PC Richard
PortableAirShop.com
RONA
Shopko
SimpleDehumidifiers.com
Sportsman’s Guide
Stoneberry
Superco
Target
United Hardware
Wakefern
Walmart.com
WineCoolerDirect.com
Other
Proof of Purchase
Optional
File
Purchase Price
Optional
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