Extended Warranty Form

Please fill in the application below for an assessment of your extended warranty.

Customer Name
Business Name (if applicable)
Customer Address*
Telephone Number*
Email Address*
Supplier Name
Supplier Address
Product Code*
Batch Number/s
Quantity*
Installation Date
Installation Address*
Description of installation (Hospital, School, etc)
Average Daily Use (Hours)
Environmental Factors (Please Select)*
Lighting Controls (Please Select)*
Confirm Info
- Confirm Info
I confirm that the information given is true & accurate to the best of my knowledge
Confirm Terms
- Confirm Terms
I have read and agree to the terms & conditions of the warranty policy, which can be found at www.kosnic.com/warranty-policy
Confirm No Marketing
- Confirm No Marketing
I would not like to receive any further marketing information from Kosnic (UK) Ltd (Any personal information you give to us will be processed in accordance with the UK Data Protection Act 1998)
Confirm Changes
- Confirm Changes
In understand that if the above stated condition change during the period of the warranty, Kosnic reserves the right to withdraw the warranty.
Comments
This field is for validation purposes and should be left unchanged.