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All information marked with an asterisk (*) is required to process your warranty.
Your Rota-dent number is found on the white warranty card that was in your box. It will start with a C followed by 2 numbers, a letter, dash, and 5 more numbers. (Example: C11N-11111)
*Warranty Registration Number:
Prefix:
Mr. Mrs. Ms.
* First Name:
* Last Name:
Postfix:
Jr. Sr. II III IV
* Address:
* City:
* Province:
Alberta British Columbia Manitoba New Brunswick NewFoundLand NorthWest Territories Nova Scotia Ontario Prince Edward Island Quebec Saskatchewan Yukon
* Postal Code:
Work Phone:
* Home Phone:
* Date Purchased (dd/mm/yy):
* E-mail Address:
Dr. Drs. Mr. Mrs.
* Dental Office Purchased From:
Dentist First Name:
* Dentist Last Name:
Address:
Postal Code:
* Office Phone:
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