:: SciCan :: Warranty Form

On-Line Warranty Form

Your SciCan Serial number is:

Your model number is:

Is this for a:

STATIM 900	STATIM 5000	STATIM 2000	Sterimaster
QUANTIM	HYDRIM L110w	HYDRIM L110wd	HYDRIM C51w

Practice/Clinic Name:

Title:

First Name:

Middle Initial:

Last Name:

Address:

City:

State/Province/Region:

Zip Code/Postal Code:

Country:

Business Phone:

Business Fax:

Email:

Dealer:

Dealer Branch/City:

Date of Purchase:

Please answer the following questions:

1. What were the deciding factors in your SciCan purchase?

Dealer Recommendation	Unit Size
Throughput Capacity	Price
Cycle Time	Effectiveness
Industry Report	Brand Name
Convenience or ease of use	Cost efficient/increased productivity

2. Including this purchase, how many sterilizers / washers / disinfectors do you currently use in your practice / clinic?
Sterilizers: Washers/Disinfectors:

3. What other SciCan products do you currently own in your practice / clinic?

Statim 2000	Statim 5000	Hydrim C51w	Hydrim L110w/wd
Quantim	Other: (please list)

4. What other washing / disinfection / sterilization products do you have in your practice / clinic? Please list.

5. May we contact you about upcoming SciCan specials and promotions?
Yes No

For the Dental Practitioners:

6. Are you working in a new practice / clinic? Yes No

7. How long have you been in your location?

Less than 1 year	1-5 yrs	6-10 yrs	15+ yrs

8. Are you planning to expand or relocate your practice / clinic?
Yes No

*Please note, SciCan will under no circumstances distribute this information to any third party.