13. Warranty (Continued)
2
Extended Warranty Agreement – AutoSealer 1002
Product Loca
�
on:
Period of Coverage:
Acct #:
Contact Name:
1 Yr. From:
To:
Phcy Name:
2 Yr. From:
To:
Address:
Serial #
City State Zip:
Item #
Descrip
�
on
1 Year
2 Years
BEST
VALUE
SAVE
10%
1002EWS
1002 Extended Warranty - Silver
Contact Rx Systems
for current pricing
1002EWG
1002 Extended Warranty - Gold
Please
sign this page (or if mul
�
ple purchases, each one should be signed), then fax or mail to Rx Systems, Inc. AN INVOICE
WILL BE MAILED IN A FEW DAYS. The terms and condi
�
ons on the next pages are part of this Agreement. Any addi
�
onal or
di
ff
erent terms proposed by the customer are rejected unless expressly agreed to in wri
�
ng by Rx Systems, Inc.
CUSTOMER EXTENDED WARRANTY AUTHORIZATION
Signature:
Print Name:
Date: P.O. # (op
�
onal)
1 Year Silver
1 Year Gold
2 Years Silver
2 Years Gold
Check the op
�
on above you wish to purchase.
Ini
�al
*below to con
fi
rm you have read Sec
�
on 9 of
.
the agreement.
This is required.
Return by mail or fax:
_______
Fax: 636-925-0041
*
Ini
�al
Rx Systems, Inc.
ATTN: Mary Terry
Provide e-mail below for future communica
�
on:
121 Point West Blvd
St. Charles, MO 63301
Email Address: _________________________________
Sign
Here
Page 17
