Diversatek Healthcare innerVision Manuel page 6

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THE FOREGOING WARRANTY WILL BE ACTIVATED AND BECOME EFFECTIVE ONLY UPON THE PURCHASER'S COMPLETION AND
SUBMISSION, AND DIVERSATEK HEALTHCARE RECEIPT OF, THIS WARRANTY REGISTRATION CARD WITHIN THIRTY (30) CALENDAR DAYS
AFTER THE PURCHASER'S RECEIPT OF THE InnerVision Transillumination Fiber Optic Cable.
Please print.
Lot Number:
Institution:
Dept.:
Address:
City:
Contact Persons:
Nurse Manager: ____________________________________
Other: _____________________
Used by:
General Surgeon GI Surgeon
Primary procedure for which this InnerVision Fiber Optic Cable is used:
_____________________________________________________
Surgeon Name(s):
_____________________________________________________
InnerVision® Transillumination System
Registration/Warranty Return Card
Date:
State: Zip:
Title: _________________ Tel: _____________________
Other: ______________________
Detach on this line and return.
Diversatek Healthcare Inc.
Country:
Tel: _____________________
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