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Machine Registration

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Machine Registration

Please fill out the following Machine Registration Form within (30) days of purchasing your machine. The warranty starts on the purchase date by the original purchaser from an authorized Mercury Floor Machines, Inc. distributor, subject to proof of purchase. If proof of purchase cannot be identified, the warranty start date is (90) days after the date of sale to an authorized Mercury Floor Machines, Inc. distributor.

Machine Registration Form
The asterisk (*) denotes required fields.

Dealer Information:
* Dealer Name:  
* Address Line 1:  
Address Line 2:
 * City:  
* State, Zip:  

 
Customer Information:
* First Name:  
* Last Name:  
* Address Line 1:  
 Address Line 2:
 * City:  
* State, Zip:  

 
* Phone:  
* E-mail Address:  
Machine Information:
* Model No:  
* Serial No:  
* Date Purchased:

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Comments:
 

 

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