5 Year Extended Warranty Registration
Please fill out and submit the following information to extend your 2 year warranty to a 5 year warranty
First Name
First Name
Option 1
Option 2
Please enter your first name
Last name
Last name
Option 1
Option 2
Please enter your last name
Email Address
Email Address
Option 1
Option 2
Please enter a valid email address
Phone Number
phone
Phone Number
Option 1
Option 2
Please specify an answer
Address
pin
Address
Option 1
Option 2
Please specify an answer
City
City
Option 1
Option 2
Please specify an answer
State
State
Option 1
Option 2
Please specify an answer
Zip
Zip
Option 1
Option 2
Please specify an answer
Serial Number or Lot Number
hash
Serial Number or Lot Number
Option 1
Option 2
Please specify an answer
*Found on the bottom label of the charger
Where did you purchase the FORM Charge charger?
1
Amazon.com
2
FORMCharge.com
3
Other
Order Information
5 Year Extended Warranty Registration
Please provide the order information and agree to the terms and conditions to complete your registration
Amazon Order Number
e-commerce-amazon-1
Amazon Order Number
Option 1
Option 2
Please match the format 114-1234567-1234567 including dashes
I have read and agree to the
terms and conditions
.
Submit
5 Year Extended Warranty Registration
Please provide the order information and agree to the terms and conditions to complete your registration
FORM Charge Order Number
hash
FORM Charge Order Number
Option 1
Option 2
Please enter a valid order number
I have read and agree to the
terms and conditions
.
Submit
5 Year Extended Warranty Registration
Please provide the order information and agree to the terms and conditions to complete your registration
Business Name purchased from
Business Name purchased from
Option 1
Option 2
Please specify an answer
Date of Purchase
Please select a date.
I have read and agree to the
terms and conditions
.
Submit
Thank you!
Your product has been registered
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