Warranty Card Submittal

Distributor/Dealer

• Distributor/Dealer Name *
• Contact person *
• Address *
• City *
• State Please Choose ...AlaskaAlabamaArkansasArizonaCaliforniaColoradoConnecticutDistrict of ColumbiaDelawareFloridaGeorgiaGuamHawaiiIowaIdahoIllinoisIndianaKansasKentuckyLouisianaMassachusettsMarylandMaineMichiganMinnesotaMissouriMississippiMontanaNorth CarolinaNorth DakotaNebraskaNew HampshireNew JerseyNew MexicoNevadaNew YorkOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVirginiaVermontVirgin IslandsWashingtonWisconsinWest VirginiaWyoming *
• ZIP Code *
• Phone number *
• E-mail address *
• Fax number *

End User

• End User Name *
• Contact person *
• Address *
• City *
• State Please Choose ...AlaskaAlabamaArkansasArizonaCaliforniaColoradoConnecticutDistrict of ColumbiaDelawareFloridaGeorgiaGuamHawaiiIowaIdahoIllinoisIndianaKansasKentuckyLouisianaMassachusettsMarylandMaineMichiganMinnesotaMissouriMississippiMontanaNorth CarolinaNorth DakotaNebraskaNew HampshireNew JerseyNew MexicoNevadaNew YorkOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVirginiaVermontVirgin IslandsWashingtonWisconsinWest VirginiaWyoming *
• ZIP code *
• Phone number *
• E-mail address *
• Fax number *
• Type of End-User Please choose... Commercial Contractor Concrete Contractor Flatwork Contractor General Contractor Government Home Builder Paving Contractor *

Equipment Information

• Equipment Information Please choose... Aluminum Truss Screed Backpack Vibrator Bridge Deck Machine Flex Shaft Vibrator High Performance Series Riding Trowel Hydra-Drive Riding Trowel M36 Air Screed Magic Screed Manual Work Bridge Material Spreader Power Sprayer Powered Work Bridge Professional Series Riding Trowel Roller Tube Finisher Steel Truss Screed Super Professional Series Riding Trowel Triple Roller Tube Paver Walk-Behind Trowel *
• Type of Equipment — Model Number *
• Equipment Serial Number(s) *
• Date Placed in Service *
• Distributor/Dealer Invoice Number *
• The Allen Equipment was Please choose... Sold Rented Leased Placed in the Rental Fleet Placed in the Demo Fleet *
• Distributor/Dealer Authorized Employee *

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