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TiLite ZR - Default Chapter; Product Registration Form

TiLite ZR
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OM_ZR_0913RevA
ZR Owner’s Manual
iii
Name:
Address:
City: State/Province:
Zip/Postal Code: Country:
PRODUCT REGISTRATION FORM
Register online at tilite.com or
complete and mail this form.
Email: Phone:
Model: Serial #:
Purchased From: Date of Purchase:
1. Method of purchase: (check all that apply)
Medicare Insurance Medicaid Other
2. This product was purchased for use by: (check one)
Self Parent Spouse Other
3. Reasons for purchasing a TiLite:
Reputation
Yes
Quality of Service:
No
Yes
Timeliness of Delivery:
No
Yes
Quality of Product:
No
Advertisement: (Please Specify)
Dealer Relative Friend Therapist/Doctor
4. Were your expectations met in the following areas? If not, please specify.
5. What additional features, if any, would you like to see on this or future TiLite products?
CUT ALONG LINE CUT ALONG LINE
FOLD HERE
FOLD HERE

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