Thank you for your new equipment purchase, in order to protect your new purchase under DUX Dental's manufacturer warranty, complete the registration form below within 10 days after receipt of the product and click on the submit button. Alternately, click here to print out the form and complete by hand, then mail to the appropriate address below.

*Dr. First Name:
*Dr. Last Name:		*Telephone:
*Address:		Fax:
Address:		*E-Mail:
*Postal code:		Type of Practice:
*City:		*Dealer:
*Country:
Equipment *Equipment purchased: Please select Alginator Dry Processor B-Tron *Model Number: *Reason for purchase: Please select New User Equipment Upgrade Additional Equipment Serial Number: (Not applicable to Alginator)   *Date of Purchase: E-mail List Opt-in Do you want to be informed of new product information and product specials?    Yes     No Anti-spam protection Please type over this control code: