Extended Warranty Registration Form

NOWA Refurbishing

Let us help you.
Customer Name*

First NameLast Name
E-mail*
example@example.com
Phone number*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Board Purchased From:
Product Information

(Must complete separate form for multiple issues)
What product is damaged:*
Tell us about the issue*
please upload as many pictures of the damage as possible

Cancelof
Should be Empty: