France Extended Warranty Program

Purchased By (Your Company Name)

Contact Name

First Last

Contact Phone

Contact Email*

Enter Email Confirm Email

This email will be used in all communication regarding this registration request.

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Purchase Order Number

Purchase Date

Distributor Company Name

Distributor Branch/Location

Check if Installation Company is Same As Above

Installed By (Company Name)

Contact Name

First Last

Contact Phone

Email

Installation Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Number of Operating Hours Per Day

Please enter a value between 1 and 24.

Number of Operating Days Per Year

Please enter a value between 1 and 365.

Product (check all that apply to this registration)

Sign Bright Kit
Fast Pak Kit
MoguLED
Power Supply
FranceFlex
TruLume Modules
TruConnect Light Sticks

Wattage (check all that apply to this registration)

120W Sign Bright Kit (LEDSB-120W)
100W Sign Bright Kit (LEDSB-100W)
75W Sign Bright Kit (LEDSB-75W)
54W Sign Bright Kit (LEDSB-54W)

120W Quantity

Please enter a value between 1 and 5000.

100W Quantity

Please enter a value between 1 and 5000.

75W Quantity

Please enter a value between 1 and 5000.

54W Quantity

Please enter a value between 1 and 5000.

Fast Pak Kits Selection (check all that apply to this registration)

Single Standard Fast Pak Kit
Single Mini Fast Pak Kit
Double Mini Fast Pak Kit

Single Standard Fast Pak Kit Quantity

Please enter a value between 1 and 5000.

Single Mini Fast Pak Kit Quantity

Please enter a value between 1 and 5000.

Double Mini Fast Pak Kit Quantity

Please enter a value between 1 and 5000.

MoguLED Lamp Selection (check all that apply to this registration)

MoguLED 120W (MGLED-120W)
MoguLED 100W (MGLED-100W)
MoguLED 75W (MGLED-75W)
MoguLED 54W (MGLED-54W)
MoguLED 45W (MGLED-45W)
MoguLED 36W (MGLED-36W)
MoguLED 27W (MGLED-27W)

120W MoguLED Quantity

Please enter a value between 1 and 5000.

100W MoguLED Quantity

Please enter a value between 1 and 5000.

75W MoguLED Quantity

Please enter a value between 1 and 5000.

54W MoguLED Quantity

Please enter a value between 1 and 5000.

45W MoguLED Quantity

Please enter a value between 1 and 5000.

36W MoguLED Quantity

Please enter a value between 1 and 5000.

27W MoguLED Quantity

Please enter a value between 1 and 5000.

France Flexx Selection (check all that apply to this registration)

White
Red
Blue
Green
Orange
Yellow

Flexx Curv White Length

0 of 120 max characters

Flexx Curv Red Length

0 of 120 max characters

Flexx Curv Blue Length

0 of 120 max characters

Flexx Curv Green Length

0 of 120 max characters

Flexx Curv Orange Length

0 of 120 max characters

Flexx Curv Yellow Length

0 of 120 max characters

Power Supply Selection (check all that apply to this registration)

DRV-1230-E Power Supply Quantity

Please enter a value between 1 and 5000.

DRV-1260-E Power Supply Quantity

Please enter a value between 1 and 5000.

DRV-12120-E Power Supply Quantity

Please enter a value between 1 and 5000.

DRV-1260-A Power Supply Quantity

Please enter a value between 1 and 5000.

DRV-12120-A Power Supply Quantity

Please enter a value between 1 and 5000.

DRV-2430-E Power Supply Quantity

Please enter a value between 1 and 5000.

DRV-2460-E Power Supply Quantity

Please enter a value between 1 and 5000.

DRV-24100-E Power Supply Quantity

Please enter a value between 1 and 5000.

DRV-2460-A Power Supply Quantity

Please enter a value between 1 and 5000.

DRV-24100-A Power Supply Quantity

Please enter a value between 1 and 5000.

TruLume Modules Selection (check all that apply to this registration)

Uno LED Module
Duo LED Module
Trio LED Module
Quattro LED Module

Uno LED Module Quantity

Please enter a value between 1 and 5000.

Duo LED Module Quantity

Please enter a value between 1 and 5000.

Trio LED Module Quantity

Please enter a value between 1 and 5000.

Quattro LED Module Quantity

Please enter a value between 1 and 5000.

TruConnect Light Stick Selection (check all that apply to this registration)

Single Sided
Double Sided

Single Sided Dimensions

0 of 120 max characters

Double Sided Dimensions

0 of 120 max characters