AesthetixIQ Device Warranty Registration Form

Company Name *

First Name

Last Name

Phone *

Email *

Address

Street Address

City

State

Country

Country

Postal Code

Website (optional)

Device Model *

Serial / ID Number (on back of device) *

Order / Invoice Number

Date Device Received / Installed *

Upload Unboxing Video *

PDF, DOC/DOCX, XLS/CSV, JPG/JPEG, PNG, GIF

Upload Invoice (optional)

PDF, DOC/DOCX, XLS/CSV, JPG/JPEG, PNG, GIF

Any issues within 7 days? *

No

Yes

List issues: *

Please upload pictures or video of the issues: *

PDF, DOC/DOCX, XLS/CSV, JPG/JPEG, PNG, GIF

I agree to warranty terms and that all information submitted on my behalf is true to the best of my knowledge and that any falsehood could result in the cancellation of my warranty.

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