E-Warranty Registration Form | Thailand

1
Company Details* This field is required.As per business license
Company Name
Business Registration Number
Company Contact Number
2
Contact Person Details* This field is required.
Full Name
Male
Female
Others
Gender
Designation
Contact Number
Email Address
3
Address* This field is required.The location where Medklinn Air+Surface Sterilizer OR Ozone Water System is installed
Address
Street Address
City
State
Postcode
Thailand
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
4
Please upload your original invoice (s).* This field is required.
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Cancelof
5
Please upload your original receipts (s).* This field is required.
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Cancelof
6
Purchased from* This field is required.
Medklinn Thailand
Other Distributor / Dealer
Others
7
Other Distributor / Dealer* This field is required.
Distributor / Dealer Company Name
8
Others* This field is required.
9
Date of Purchase* This field is required.
Date
Year
Month
Day
10
Number of Unit(s)* This field is required.
Please Select
Please Select
1
2
3
4
5
6
7
8
9
10
11
12
13
14
11
Product Model 1* This field is required.
Please Select
Please Select
PRO AS1
PRO AS2
PRO AS3
PRO AS20P
PRO AS30P
PRO AS40P
PRO AS50G
PRO AS180
PRO AS150D
PRO AS150DF
PRO AS300D
PRO AS500D
PRO AS750D
PRO AS1000D
O3 HYDRO 5
O3 HYDRO 10
O3 HYDRO 20
O3 HYDRO 30
O3 HYDRO 40
O3 HYDRO 50
O3 HYDRO JETSPRAY
INT 10
INT 20
INT 30
INT 40
INT 50
Ex: 348-BB-01-12345
12
Product Model 2* This field is required.
Please Select
Please Select
PRO AS1
PRO AS2
PRO AS3
PRO AS20P
PRO AS30P
PRO AS40P
PRO AS50G
PRO AS180
PRO AS150D
PRO AS150DF
PRO AS300D
PRO AS500D
PRO AS750D
PRO AS1000D
O3 HYDRO 5
O3 HYDRO 10
O3 HYDRO 20
O3 HYDRO 30
O3 HYDRO 40
O3 HYDRO 50
O3 HYDRO JETSPRAY
INT 10
INT 20
INT 30
INT 40
INT 50
Ex: 348-BB-01-12345
13
Product Model 3* This field is required.
Please Select
Please Select
PRO AS1
PRO AS2
PRO AS3
PRO AS20P
PRO AS30P
PRO AS40P
PRO AS50G
PRO AS180
PRO AS150D
PRO AS150DF
PRO AS300D
PRO AS500D
PRO AS750D
PRO AS1000D
O3 HYDRO 5
O3 HYDRO 10
O3 HYDRO 20
O3 HYDRO 30
O3 HYDRO 40
O3 HYDRO 50
O3 HYDRO JETSPRAY
INT 10
INT 20
INT 30
INT 40
INT 50
Ex: 348-BB-01-12345
14
Product Model 4* This field is required.
Please Select
Please Select
PRO AS1
PRO AS2
PRO AS3
PRO AS20P
PRO AS30P
PRO AS40P
PRO AS50G
PRO AS180
PRO AS150D
PRO AS150DF
PRO AS300D
PRO AS500D
PRO AS750D
PRO AS1000D
O3 HYDRO 5
O3 HYDRO 10
O3 HYDRO 20
O3 HYDRO 30
O3 HYDRO 40
O3 HYDRO 50
O3 HYDRO JETSPRAY
INT 10
INT 20
INT 30
INT 40
INT 50
Ex: 348-BB-01-12345
15
Product Model 5* This field is required.
Please Select
Please Select
PRO AS1
PRO AS2
PRO AS3
PRO AS20P
PRO AS30P
PRO AS40P
PRO AS50G
PRO AS180
PRO AS150D
PRO AS150DF
PRO AS300D
PRO AS500D
PRO AS750D
PRO AS1000D
O3 HYDRO 5
O3 HYDRO 10
O3 HYDRO 20
O3 HYDRO 30
O3 HYDRO 40
O3 HYDRO 50
O3 HYDRO JETSPRAY
INT 10
INT 20
INT 30
INT 40
INT 50
Ex: 348-BB-01-12345
16
Product Model 6* This field is required.
Please Select
Please Select
PRO AS1
PRO AS2
PRO AS3
PRO AS20P
PRO AS30P
PRO AS40P
PRO AS50G
PRO AS180
PRO AS150D
PRO AS150DF
PRO AS300D
PRO AS500D
PRO AS750D
PRO AS1000D
O3 HYDRO 5
O3 HYDRO 10
O3 HYDRO 20
O3 HYDRO 30
O3 HYDRO 40
O3 HYDRO 50
O3 HYDRO JETSPRAY
INT 10
INT 20
INT 30
INT 40
INT 50
Ex: 348-BB-01-12345
17
Product Model 7* This field is required.
Please Select
Please Select
PRO AS1
PRO AS2
PRO AS3
PRO AS20P
PRO AS30P
PRO AS40P
PRO AS50G
PRO AS180
PRO AS150D
PRO AS150DF
PRO AS300D
PRO AS500D
PRO AS750D
PRO AS1000D
O3 HYDRO 5
O3 HYDRO 10
O3 HYDRO 20
O3 HYDRO 30
O3 HYDRO 40
O3 HYDRO 50
O3 HYDRO JETSPRAY
INT 10
INT 20
INT 30
INT 40
INT 50
Ex: 348-BB-01-12345
18
Product Model 8* This field is required.
Please Select
Please Select
PRO AS1
PRO AS2
PRO AS3
PRO AS20P
PRO AS30P
PRO AS40P
PRO AS50G
PRO AS180
PRO AS150D
PRO AS150DF
PRO AS300D
PRO AS500D
PRO AS750D
PRO AS1000D
O3 HYDRO 5
O3 HYDRO 10
O3 HYDRO 20
O3 HYDRO 30
O3 HYDRO 40
O3 HYDRO 50
O3 HYDRO JETSPRAY
INT 10
INT 20
INT 30
INT 40
INT 50
Ex: 348-BB-01-12345
19
Product Model 9* This field is required.
Please Select
Please Select
PRO AS1
PRO AS2
PRO AS3
PRO AS20P
PRO AS30P
PRO AS40P
PRO AS50G
PRO AS180
PRO AS150D
PRO AS150DF
PRO AS300D
PRO AS500D
PRO AS750D
PRO AS1000D
O3 HYDRO 5
O3 HYDRO 10
O3 HYDRO 20
O3 HYDRO 30
O3 HYDRO 40
O3 HYDRO 50
O3 HYDRO JETSPRAY
INT 10
INT 20
INT 30
INT 40
INT 50
Ex: 348-BB-01-12345
20
Product Model 10* This field is required.
Please Select
Please Select
PRO AS1
PRO AS2
PRO AS3
PRO AS20P
PRO AS30P
PRO AS40P
PRO AS50G
PRO AS180
PRO AS150D
PRO AS150DF
PRO AS300D
PRO AS500D
PRO AS750D
PRO AS1000D
O3 HYDRO 5
O3 HYDRO 10
O3 HYDRO 20
O3 HYDRO 30
O3 HYDRO 40
O3 HYDRO 50
O3 HYDRO JETSPRAY
INT 10
INT 20
INT 30
INT 40
INT 50
Ex: 348-BB-01-12345
21
Product Model 11* This field is required.
Please Select
Please Select
PRO AS1
PRO AS2
PRO AS3
PRO AS20P
PRO AS30P
PRO AS40P
PRO AS50G
PRO AS180
PRO AS150D
PRO AS150DF
PRO AS300D
PRO AS500D
PRO AS750D
PRO AS1000D
O3 HYDRO 5
O3 HYDRO 10
O3 HYDRO 20
O3 HYDRO 30
O3 HYDRO 40
O3 HYDRO 50
O3 HYDRO JETSPRAY
INT 10
INT 20
INT 30
INT 40
INT 50
Ex: 348-BB-01-12345
22
Product Model 12* This field is required.
Please Select
Please Select
PRO AS1
PRO AS2
PRO AS3
PRO AS20P
PRO AS30P
PRO AS40P
PRO AS50G
PRO AS180
PRO AS150D
PRO AS150DF
PRO AS300D
PRO AS500D
PRO AS750D
PRO AS1000D
O3 HYDRO 5
O3 HYDRO 10
O3 HYDRO 20
O3 HYDRO 30
O3 HYDRO 40
O3 HYDRO 50
O3 HYDRO JETSPRAY
INT 10
INT 20
INT 30
INT 40
INT 50
Ex: 348-BB-01-12345
23
Product Model 13* This field is required.
Please Select
Please Select
PRO AS1
PRO AS2
PRO AS3
PRO AS20P
PRO AS30P
PRO AS40P
PRO AS50G
PRO AS180
PRO AS150D
PRO AS150DF
PRO AS300D
PRO AS500D
PRO AS750D
PRO AS1000D
O3 HYDRO 5
O3 HYDRO 10
O3 HYDRO 20
O3 HYDRO 30
O3 HYDRO 40
O3 HYDRO 50
O3 HYDRO JETSPRAY
INT 10
INT 20
INT 30
INT 40
INT 50
Ex: 348-BB-01-12345
24
Product Model 14* This field is required.
Please Select
Please Select
PRO AS1
PRO AS2
PRO AS3
PRO AS20P
PRO AS30P
PRO AS40P
PRO AS50G
PRO AS180
PRO AS150D
PRO AS150DF
PRO AS300D
PRO AS500D
PRO AS750D
PRO AS1000D
O3 HYDRO 5
O3 HYDRO 10
O3 HYDRO 20
O3 HYDRO 30
O3 HYDRO 40
O3 HYDRO 50
O3 HYDRO JETSPRAY
INT 10
INT 20
INT 30
INT 40
INT 50
Ex: 348-BB-01-12345
25
Warranty Terms & Conditions* This field is required.
26
Privacy Policy* This field is required.
27
Please verify that you are human* This field is required.
28
Email
example@example.com
Should be Empty: