Pure Heat™ Warranty

First Name			Last Name
Company:
Address:			City:
State:			Zip:
Phone:			Cellphone:
E-mail:

Product:			Quantity Purchased:
Where Purchased:			Date Purchased:



Completing this form does not take the place of proof of purchase. PLEASE RETAIN A COPY OF YOUR RECEIPT as it will be required if the product needs to be replaced.