Purchaser Name: *

Contact Person: *

Email: *

Phone: *

Fax: *

Address/City/State/Postal Code: *

Would you like to receive Ashland's quarterly newsletter?

Yes No

Model Purchased: *

Serial Number: *

Purchased Date: *

Would you like to receive updates about your machine?

Yes No

IMPORTANT! I hereby acknowledge that I have received the owners and parts manuals for the machine listed. I understand that operation of the machine should not be attempted before the manuals provided have been fully read and understood. Operators who are unfamiliar with the machine should not attempt to operate. PURCHASER E-SIGNATURE: *

Dated: *