Form Builder

Reason for website visit today

Device being registered

Model (choose one)

Serial number

On the back of the AED, there is a 9-digit serial number label.

Must be 9 digits and begin with a 1, 2, 3 or 4.

Serial number

The serial number is a label on the back of the AED. Remove the pads from their holder to expose the 9-digit serial number label.

Must be 9 digits and begin with a 1, 2, 3 or 4.

Contact person responsible for the product

(to whom product notices and updates will be sent)

First Name

Last Name

Title

Company

Phone Number

Fax

Physical address of where product is located

(no post office or similar box numbers because product notices may require delivery confirmation)

Contact

(if different than above)

Company

(if different than above)

Address 1

Address 2

City

State/County/Province

Postal Code/Zip Code

Country

Additional information

Purchased/Acquired date

Purchased from

Please take a moment to review your information before submitting, this is the last step.

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