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WARRANTY FORM
The Warranty Form must be filled out completely and mailed to:
American Changer Corp.
1400 NW 65
th
Place
Ft. Lauderdale, FL 33309
Attention: Extended Warranty Department
Machine Information
Machine Model & Serial Number:
____________________________________
Validator Serial Number:
____________________________________
Validator Serial Number:
____________________________________
Hopper Serial Number:
____________________________________
Hopper Serial Number:
____________________________________
Logic Board Serial Number:
____________________________________
Coin Mechanism Serial Number:
____________________________________
Your Name:
____________________________________
Company Name:
____________________________________
Billing Address:
____________________________________
Billing Address:
____________________________________
City:
____________________________________
State and Zip Code:
____________________________________
Phone Number:
____________________________________
Email Address:
____________________________________
Note: The purpose of this form is to enter your information in our customer database. This information will not be
shared with anyone outside of American Changer Corp. It will be used to inform you of equipment upgrade
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