6
PR
O
D
U
C
T R
E
G
ISTR
A
TI
O
N
I ha
v
e
r
e
a
d
a
n
d
un
de
rs
tan
d
t
h
is
p
ro
d
u
c
t's
op
e
rat
io
n
a
nd
w
a
rr
an
ty
,
a
nd
w
is
h t
o
r
ec
o
rd
m
y
p
ur
c
h
a
s
e
:
M
o
de
l:
__
_
__
_
_
__
_
_
__
_
__
_
__
__
_
_
__
_
_
__
_
N
a
me
(M
r.
/Mr
s
./
Ms
.
):
_
_
__
_
__
__
_
_
_
__
_
_
__
__
_
__
_
__
_
_
_
__
_
A
dd
re
s
s
:_
_
__
__
_
_
__
_
_
__
_
__
_
__
_
_
_
__
_
__
__
_
_
__
__
_
_
_
__
_
__
_
_
C
it
y
:_
_
__
__
_
_
_
__
_
_
_
Pr
ovi
nc
e
:__
__
_
_
_
__
__
_
Pos
ta
l C
od
e
:_
_
_
__
_
__
__
_
_
_
_
T
e
l:
_
__
__
_
__
_
_
__
E
m
a
il_
_
__
__
_
__
__
__
_
__
__
_
_
D
a
te
o
f
P
ur
c
h
as
e
:
_
__
_
__
_
__
__
_
_
_N
am
e
o
f S
to
re/
D
e
a
le
r:
_
_
__
__
_
_
__
_
__
_
_
__
_
R
o
un
d
s
o
f
G
o
lf
p
e
r
M
o
nt
h:
_
_
__
_
__
_
__
_
_
__
_
H
'C
A
P
_
_
__
_
__
_
__
__
_
__
_
_
__
__
_
_
S
ig
ne
d
:_
_
_
__
_
__
_
_
__
_
_
_
__
_
__
_
_
__
D
a
te:
_
__
_
_
__
_
__
_
_
__
__
_
__
_
__
_
_
F
ai
lur
e
to
r
e
tu
rn
t
h
is
c
a
rd
m
ay
r
e
s
u
lt
i
n
d
el
a
y
ed
r
e
s
p
o
ns
e
t
o
y
o
u
r
w
a
rr
a
n
ty
c
lai
m
