| The benefits of registering include: |
| 1. Safeguarding your investment. |
| 2. Ensuring long-term maintenance and servicing of your product. |
3. Receiving updates with product information, maintenance tips, and industry news.
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| Items with a * are required. |
| First Name * |
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| Last Name * |
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| Address Line 1 * |
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| Address Line 2 |
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| City * |
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| State / Province * |
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| Zip / Postal Code * |
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| Country * |
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| Email |
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| Phone Number |
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| Model Number * |
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| Serial Number |
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| Purchased From |
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| Purchase Date * |
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(mm/dd/yyyy)
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About You |
1. Method of purchase: (check all that apply)
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2. This product was purchased for use by (check one)
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3. Product was purchased for use at:
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4. I purchased this Invacare product because:
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4a. If you selected "Features" please describe:
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5. How did you learn about Invacare's products?
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6. What additional features would you like to see on this product?
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7. Would you like information sent to you about Invacare products that may be available for a particular medical condition?
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7a. If yes, please list any condition(s) here and we will send you information by email and/or mail about any available Invacare products that may help treat, care for, or manage such condition(s).
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8. Would you like to receive updated information via email about Invacare medical products?
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9. What would you like to see on the Invacare website?
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10. Would you like to be part of future online surveys for Invacare products?
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| 11. User's year of birth |
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