Atek, Inc.

WARRANTY REGISTRATION

U.S. and Canadian customers only, please fill out this form to register the purchase of your Atek Electronics product:

Required fields marked with *

Name:*

Title:

Company name:

Address:*

City:* State/Province:* Zip/Postal code:*

Telephone:

Fax:

E-mail address:

Atek model no.*

Serial number:*

Date of purchase:*

Purchase price:

Name of merchant where purchased:

Type of merchant where purchased:

Where did you hear about Atek?

What is the main reason you chose an Atek product?

Comments or suggestions:

Please email me occasional information on products and services from Atek's
partners and affiliates that may be of interest to me.

Thank you for taking time to fill out this form.