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<h1>Warranty Registration</h1>
Activate your product’s warranty to be eligible for special benefits with Paintball Solutions.
<p>
Fields indicated with a “<font color=”Red”>*</font>” are required.
<form method=”post” action=”http://www.paintballsolutions.com/05pb_solutions/warranty_registration.php”>

<input type=”HIDDEN” name=”Active” value=”true” />
<table width=”680″ border=”0″ align=”center” cellpadding=”1″ cellspacing=”1″ class=”formcopy”>
<tr>
<td colspan=”2″ align=”center” valign=”top”>
<table width=”650″ border=”0″ cellspacing=”0″ cellpadding=”0″ class=”formcopy”>

<tr valign=”middle”>
<td width=”127″ align=”right”><font color=”Red”>*</font><span id=”_First_name”>First Name:</span>&nbsp;</td>
<td width=”180″><input name=”_First_name” type=”text” id=”_First_name” size=”30″ maxlength=”50″ value=”" /></td>

<td width=”150″ align=”right”><font color=”Red”>*</font><span id=”_Last_name”>Last Name:</span>&nbsp;</td>
<td width=”183″><input name=”_Last_name” type=”text” id=”_Last_name” size=”30″ maxlength=”50″ value=”" /></td>
</tr>

<tr valign=”middle”>
<td align=”right”><font color=”Red”>*</font><span id=”_address”>Street Address:</span>&nbsp;</td>
<td><input name=”_address” type=”text” id=”_Address” size=”30″ maxlength=”50″ value=”" /></td>
<td align=”right”>Address 2:&nbsp;</td>

<td><input name=”address2″ type=”text” id=”Address2″ size=”30″ maxlength=”50″ value=”" /></td>
</tr>

<tr valign=”middle”>
<td align=”right”><font color=”Red”>*</font><span id=”_City”>City:</span>&nbsp;</td>
<td><input name=”_City” type=”text” id=”_City” size=”30″ maxlength=”50″ value=”" /></td>
<td align=”right”><font color=”Red”>*</font><span id=”_State”>State:</span>&nbsp;</td>
<td>

<select name=”_State” size=”1″ id=”_State” value=”">
<option selected value=”choose state”>Choose State</option>
<option value=”AL”>Alabama</option>
<option value=”AK”>Alaska</option>
<option value=”AZ”>Arizona</option>
<option value=”AR”>Arkansas</option>

<option value=”CA”>California</option>
<option value=”CO”>Colorado</option>
<option value=”CT”>Connecticut</option>
<option value=”DE”>Delaware</option>
<option value=”FL”>Florida</option>
<option value=”GA”>Georgia</option>

<option value=”HI”>Hawaii</option>
<option value=”ID”>Idaho</option>
<option value=”IL”>Illinois</option>
<option value=”IN”>Indiana</option>
<option value=”IA”>Iowa</option>
<option value=”KS”>Kansas</option>

<option value=”KY”>Kentucky</option>
<option value=”LA”>Louisiana</option>
<option value=”ME”>Maine</option>
<option value=”MD”>Maryland</option>
<option value=”MA”>Massachusetts</option>
<option value=”MI”>Michigan</option>

<option value=”MN”>Minnesota</option>
<option value=”MS”>Mississippi</option>
<option value=”MO”>Missouri</option>
<option value=”MT”>Montana</option>
<option value=”NE”>Nebraska</option>
<option value=”NV”>Nevada</option>

<option value=”NH”>New Hampshire</option>
<option value=”NJ”>New Jersey</option>
<option value=”NM”>New Mexico</option>
<option value=”NY”>New York</option>
<option value=”NC”>North Carolina</option>
<option value=”ND”>North Dakota</option>

<option value=”OH”>Ohio</option>
<option value=”OK”>Oklahoma</option>
<option value=”OR”>Oregon</option>
<option value=”PA”>Pennsylvania</option>
<option value=”RI”>Rhode Island</option>
<option value=”SC”>South Carolina</option>

<option value=”SD”>South Dakota</option>
<option value=”TN”>Tennessee</option>
<option value=”TX”>Texas</option>
<option value=”UT”>Utah</option>
<option value=”VT”>Vermont</option>
<option value=”VA”>Virginia</option>

<option value=”WA”>Washington</option>
<option value=”DC”>Washinton, D.C.</option>
<option value=”WV”>West Virginia</option>
<option value=”WI”>Wisconsin</option>
<option value=”WY”>Wyoming</option>
</select>

</td>
</tr>

<tr valign=”middle”>
<td align=”right”>&nbsp;<font color=”Red”>*</font><span id=”_Zip”>Zip:</span>&nbsp;</td>
<td><input name=”_Zip” type=”text” size=”10″ maxlength=”18″ value=”" /></td>
<td align=”right”>Country:&nbsp;</td>
<td><INPUT maxLength=”50″ size=”30″ name=”Country” value=”" /></td>

</tr>

<tr valign=”middle”>
<td height=”25″ align=”right”><font color=”Red”>*</font><span id=”Email”>Email Address:</span>&nbsp;</td>
<td><input name=”Email” type=”text” size=”30″ maxlength=”50″ value=”" /></td>
<td align=”right”><font color=”Red”>*</font><span id=”_Phone”>Home Phone:</span>&nbsp;</td>
<td><input name=”_Phone” type=”text” size=”10″ maxlength=”20″ value=”" /></td>
</tr>

<tr valign=”middle”>
<td align=”right”><font color=”Red”>*</font><span id=”_DOP_day”><span id=”_DOP_month”><span id=”_DOP_year”>Date Purchased:</span></span></span>&nbsp;</td>
<td><input name=”_DOP_month” type=”text” size=”2″ maxlength=”2″ value=”" />/
<input name=”_DOP_day” type=”text” size=”2″ maxlength=”2″ value=”" />/<input name=”_DOP_year” type=”text” size=”4″ maxlength=”4″ value=”" /></td>
<td align=”right”><font color=”Red”>*</font><span id=”_Price”>Purchase Price:</span>&nbsp;</td>
<td><input name=”_Price” type=”text” size=”6″ maxlength=”8″ value=”" /></td>
</tr>

<tr align=”center” valign=”middle”>
<td colspan=”4″><font color=”Red”>*</font><span id=”_Purchased_from”>Name of store or website where purchased:</span>&nbsp;<input name=”_Purchased_from” type=”text” size=”30″ maxlength=”60″ value=”" /></td>
</tr>
</table>
</td>
</tr>
<tr>
<td colspan=”2″ align=”center”><img src=”../ps05/gfx/blue_pixel2.gif” alt=”" width=”500″ height=”1″ border=”0″ vspace=”6″></td>

</tr>
<tr valign=”middle”>
<td colspan=”2″>
Please select the product you wish to register from the drop down box below and indicate the appropriate quantity. If registering more than one different product, use the additional boxes.<br><br>
<table width=”650″ border=”0″ align=”center” cellpadding=”0″ cellspacing=”0″>
<tr valign=”middle”>
<td width=”86″ align=”right”><font color=”Red”>*</font><span id=”_Prod1_model”>Product 1:</span>&nbsp;</td>
<td width=”254″><SELECT name=”_Prod1_model” size=1 id=”_Prod1_model”>

<OPTION selected >(choose model)</OPTION>

<option>————Paintball Markers———–</option>

<option >Black Maxx 55</option>

<option >Diablo Wrath</option>

<option >Diablo Wrath LTD</option>

<option >Diablo Mongoose II BBS (with eyes) - LCD</option>

<option >Diablo Mongoose II Standard</option>

<option >Diablo Mongoose II LCD</option>

<option >Evil Omen</option>

<option >Evil Pimp</option>

<option >Evil Minion</option>

<option >PCS US-5</option>

<option >PCS USP</option>

<option >Piranha R6</option>

<option >Piranha GTI</option>

<option >Piranha SRT</option>

<option >Piranha EXT</option>

<option >Piranha EVO</option>

<option >BT TM 7</option>

<option >Invert Mini</option>

<option>———–Motorized Hoppers————</option>

<option >Empire Magna</option>

<option >Empire Reloader B</option>

<option >Empire Reloader B2</option>

<option >Halo B</option>

<option >Halo B with Victory Board</option>

<option >Halo TSA LED</option>

<option >Halo TSA LCD</option>

</SELECT>
</td>

<td width=”104″ align=”right”><font color=”Red”>*</font><span id=”_Prod1_color”>Color:</span>&nbsp;</td>
<td width=”176″><input name=”_Prod1_color” type=”text” id=”_Prod1_color” size=”20″ maxlength=”20″ value=”" /></td>
</tr>
<tr valign=”middle”>
<td align=”right”><font color=”Red”>*</font><span id=”_Prod1_qty”>Qty:</span>&nbsp;</td>
<td><input name=”_Prod1_qty” type=”text” id=”_Prod1_qty” size=”4″ maxlength=”4″ value=”" /></td>
<td align=”right”>Serial Number:&nbsp;</td>

<td><input name=”Prod1_serial” type=”text” id=”Prod1_serial” size=”20″ maxlength=”60″ value=”" /></td>
</tr>
<tr valign=”middle”>
<td align=”right”>Product 2:&nbsp;</td>
<td><SELECT name=”Prod2_model” size=1 id=”Prod2_model”>

<OPTION selected >(choose model)</OPTION>

<option>————Paintball Markers———–</option>

<option >Black Maxx 55</option>

<option >Diablo Wrath</option>

<option >Diablo Wrath LTD</option>

<option >Diablo Mongoose II BBS (with eyes) - LCD</option>

<option >Diablo Mongoose II Standard</option>

<option >Diablo Mongoose II LCD</option>

<option >Evil Omen</option>

<option >Evil Pimp</option>

<option >Evil Minion</option>

<option >PCS US-5</option>

<option >PCS USP</option>

<option >Piranha R6</option>

<option >Piranha GTI</option>

<option >Piranha SRT</option>

<option >Piranha EXT</option>

<option >Piranha EVO</option>

<option >BT TM 7</option>

<option >Invert Mini</option>

<option>———–Motorized Hoppers————</option>

<option >Empire Magna</option>

<option >Empire Reloader B</option>

<option >Empire Reloader B2</option>

<option >Halo B</option>

<option >Halo B with Victory Board</option>

<option >Halo TSA LED</option>

<option >Halo TSA LCD</option>
</SELECT>
</td>
<td align=”right”>Qty:&nbsp;</td>
<td><input name=”Prod2_qty” type=”text” id=”Prod2_qty” size=”4″ maxlength=”4″ value=”" /></td>
</tr>

<tr valign=”middle”>
<td align=”right”>Color:&nbsp;</td>
<td><input name=”Prod2_color” type=”text” id=”Prod2_color” size=”20″ maxlength=”20″ value=”" /></td>
<td align=”right”>Serial Number:&nbsp;</td>
<td><input name=”Prod2_serial” type=”text” id=”Prod2_serial” size=”20″ maxlength=”60″ value=”" /></td>
</tr>
<tr valign=”middle”>
<td align=”right”>Product 3:&nbsp;</td>

<td><SELECT name=”Prod3_model” size=1 id=”Prod3_model”>

<OPTION selected >(choose model)</OPTION>

<option>————Paintball Markers———–</option>

<option >Black Maxx 55</option>

<option >Diablo Wrath</option>

<option >Diablo Wrath LTD</option>

<option >Diablo Mongoose II BBS (with eyes) - LCD</option>

<option >Diablo Mongoose II Standard</option>

<option >Diablo Mongoose II LCD</option>

<option >Evil Omen</option>

<option >Evil Pimp</option>

<option >Evil Minion</option>

<option >PCS US-5</option>

<option >PCS USP</option>

<option >Piranha R6</option>

<option >Piranha GTI</option>

<option >Piranha SRT</option>

<option >Piranha EXT</option>

<option >Piranha EVO</option>

<option >BT TM 7</option>

<option >Invert Mini</option>

<option>———–Motorized Hoppers————</option>

<option >Empire Magna</option>

<option >Empire Reloader B</option>

<option >Empire Reloader B2</option>

<option >Halo B</option>

<option >Halo B with Victory Board</option>

<option >Halo TSA LED</option>

<option >Halo TSA LCD</option>

</SELECT>

</td>
<td align=”right”>Qty:&nbsp;</td>
<td><input name=”Prod3_qty” type=”text” id=”Prod3_qty” size=”4″ maxlength=”4″ value=”" /></td>
</tr>
<tr valign=”middle”>
<td align=”right”>Color:&nbsp;</td>
<td><input name=”Prod3_color” type=”text” id=”Prod3_color” size=”20″ maxlength=”20″ value=”" /></td>
<td align=”right”>Serial Number:&nbsp;</td>

<td><input name=”Prod3_serial” type=”text” id=”Prod3_serial” size=”20″ maxlength=”60″ value=”" /></td>
</tr>
<tr valign=”middle”>
<td align=”right”>Product 4:&nbsp;</td>
<td><SELECT name=”Prod4_model” size=1 id=”Prod4_model”>

<OPTION selected >(choose model)</OPTION>

<option>————Paintball Markers———–</option>

<option >Black Maxx 55</option>

<option >Diablo Wrath</option>

<option >Diablo Wrath LTD</option>

<option >Diablo Mongoose II BBS (with eyes) - LCD</option>

<option >Diablo Mongoose II Standard</option>

<option >Diablo Mongoose II LCD</option>

<option >Evil Omen</option>

<option >Evil Pimp</option>

<option >Evil Minion</option>

<option >PCS US-5</option>

<option >PCS USP</option>

<option >Piranha R6</option>

<option >Piranha GTI</option>

<option >Piranha SRT</option>

<option >Piranha EXT</option>

<option >Piranha EVO</option>

<option >BT TM 7</option>

<option >Invert Mini</option>

<option>———–Motorized Hoppers————</option>
<option >Empire Magna</option>

<option >Empire Reloader B</option>

<option >Empire Reloader B2</option>

<option >Halo B</option>

<option >Halo B with Victory Board</option>

<option >Halo TSA LED</option>

<option >Halo TSA LCD</option>
</SELECT></td>

<td align=”right”>Qty:&nbsp;</td>
<td><input name=”Prod4_qty” type=”text” id=”Prod4_qty” size=”4″ maxlength=”4″ value=”" /></td>
</tr>
<tr valign=”middle”>

<td align=”right”>Color:&nbsp;</td>
<td><input name=”Prod4_color” type=”text” id=”Prod4_color” size=”20″ maxlength=”20″ value=”" /></td>
<td align=”right”>Serial Number:&nbsp;</td>
<td><input name=”Prod4_serial” type=”text” id=”Prod4_serial” size=”20″ maxlength=”60″ value=”" /></td>
</tr>
<tr valign=”middle”>
<td align=”right”>Product 5:&nbsp;</td>

<td><SELECT name=”Prod5_model” size=1 id=”Prod5_model”>

<OPTION selected >(choose model)</OPTION>

<option>————Paintball Markers———–</option>

<option >Black Maxx 55</option>

<option >Diablo Wrath</option>

<option >Diablo Wrath LTD</option>

<option >Diablo Mongoose II BBS (with eyes) - LCD</option>

<option >Diablo Mongoose II Standard</option>

<option >Diablo Mongoose II LCD</option>

<option >Evil Omen</option>

<option >Evil Pimp</option>

<option >Evil Minion</option>

<option >PCS US-5</option>

<option >PCS USP</option>

<option >Piranha R6</option>

<option >Piranha GTI</option>

<option >Piranha SRT</option>

<option >Piranha EXT</option>

<option >Piranha EVO</option>

<option >BT TM 7</option>

<option >Invert Mini</option>

<option>———–Motorized Hoppers————</option>
<option >Empire Magna</option>

<option >Empire Reloader B</option>

<option >Empire Reloader B2</option>

<option >Halo B</option>

<option >Halo B with Victory Board</option>

<option >Halo TSA LED</option>

<option >Halo TSA LCD</option>
</SELECT></td>

<td align=”right”>Qty:&nbsp;</td>
<td><input name=”Prod5_qty” type=”text” id=”Prod5_qty” size=”4″ maxlength=”4″ value=”" /></td>
</tr>
<tr valign=”middle”>
<td align=”right”>
Color:&nbsp;</td>
<td><input name=”Prod5_color” type=”text” id=”Prod5_color” size=”20″ maxlength=”20″ value=”" /></td>
<td align=”right”>Serial Number:&nbsp;</td>

<td><input name=”Prod5_serial” type=”text” id=”Prod5_serial” size=”20″ maxlength=”60″ value=”" /></td>
</tr>
</table>
</td>
</tr>
<tr align=”center” valign=”middle”>
<td colspan=”2″>Enter any additional comments in the space below:<br> <textarea name=”Comments” cols=”75″ rows=”10″></textarea></td>
</tr>

<tr valign=”middle”>
<td width=”337″ align=”right” valign=”middle”><input type=”reset” value=”Reset”> &nbsp;</td>
<td width=”336″>&nbsp; <input type=”submit” value=”Submit!”></td>
</tr>
</table>
</form>
</td>
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</table>