Our Warranty Registration Form

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Registration Form

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Name
Enter Your Name
Enter Valid Name(only Character min 3)
Email
Enter Your MailId
Enter Valid MailId(someone@some.com)
Phone Number
Enter Your Phone Number
Enter Valid Phone Number(Only Numeric Values)
Address
Enter Your Address
Enter Valid Address
Enter Your Address
Enter Valid Address
City
Enter Valid City(only characters)
State
Enter Your State
Enter Valid State(only characters)
Postal / Zip Code
Enter Your postal code
Enter Valid Postal code(only 6 Digits)
Country
Select Your Country
Serial Number Wheelchair
Enter Your Serial number
Enter Valid Serial number(only alphanumeric)
125 T Modular Kit Number
Enter Your Modular Kit number
Enter Valid Serial number(only alphanumeric)
Purchase Date
Enter Date
Date Must Be in YYYY/MM/DD

Address

No.5. Upper Aljunied Link, #07-04 Quartz Industrial Building, SG 367903

Phone : +65 6282 4621

Fax : +65 6440 2792

Quick Contact

Name

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Phone Number

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Enter Valid Phone Number(Only Numeric Values)

Country

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Email Address

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Enter Valid MailId(someone@some.com)

Enquiry

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