New Century Warranty Registration Form
Name
Address
City
State Alabama Alaska Arizona Arkansas California Colorado Connecticut Deleware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina Tennessee Texas Utah Vermont Virginia Washington Washington DC West Virginia Wisconsin Wyoming
ZIP Code
Email Address
Additional Information
Date filter was installed Month January February March April May June July August September October November December Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Year 2008
Where did you purchase your New Century shower filter? Retail Store Mail Order Internet
Name of Store
How did you learn about the New Century shower filter Internet Friend Radio Television Newspaper Retail Store
Optional Information
We ask your help in providing us your valuable opinions. This information is very useful in helping us improve our products and customer service. 1. What effects of the New Century have you experienced during the past several days of use?
2. Have you ever used a shower/bath dechlorinator before? Yes No a. What brand? b. What were your results? Your additional comments and suggestions help Rainshow’r Mfg. bring you the finest dechlorinating filters on the market.
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