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Please fill out our Product Registration Form below to get a Product Registration ID within 30 days from purchase.

(All bolded fields are required)

Palm Massager  Product Registration Form

Contact Information:

First Name                                          Last Name  

Year Of Birth (4 digit year)

Email Address

Company Name

Address Line 1

Address Line 2

City                                                           State                                          Zip  

Phone Number

Date Of Purchase

Place Of Purchase (Provide store name or location)

Purchase Price

How Did You Hear About Us?

Additional Notes

A Product Registration ID will be emailed to you within 24 hours after you click on the 'Submit' button.

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