Warranty Registration

First Name:		Last Name:
Phone:		Email:
Street:		City:
		Postal Code:
Province:	Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Québec Saskatchewan Yukon
Gender:	Male Female
Age Bracket:	18-25 26-35 36-45 46-55 55+
Household Income:	<$20,000 $20,000-$40,000 $40,000-$60,000 $60,000-$100,000 >$100,000
Purchase Type:	Gift Personal
Watch Brand:	Lorus Lorus Clocks Pulsar Rotary Seiko Seiko Clocks Seiko Stopwatches SOMA
Case #:		8 digit hyphenated code found on back of watch case ****-****
Watch Serial #:		6 digit code found on back of watch case For clock warranty registration; please enter the MODEL NUMBER in the WATCH SERIAL NUMBER field and leave the CASE NUMBER field blank. For Pulsar & Lorus models without a WATCH SERIAL NUMBER on the back of the watch case; please enter 000000
Date of Purchase:	(yyyy-mm-dd)
Retailer Purchased At:	(retailer name and city)
Please do not email me any product updates or other communications