P.O. Box 1812
Waterbury, CT 06722
Tel. (800) 845-3495
Warranty Registration
Note: Bold fields are required.
Name/Business Name:
Street:
City:
State:
Zip:
Fax:
E-mail:
Type of Business:
Application:
select one
Odor Control
Air Freshening
Flying Insect Control
Other:
Where Used:
select one
Home
Livestock Operation
Other:
Model Purchased:
select one
Micro
Classic
Extra
Plus
Other:
Date Purchased:
(e.g. mm/dd/yyyy)
Date Manufactured
(inside dispenser):
Where Purchased (Dealer):
How did you learn
about Country Vet:
