Product Registration

Product Registration

FIRST NAME:	LAST NAME:
TITLE:
INSTITUTION:
ADDRESS:
CITY:	ST:	ZIP:
PHONE:	EXT:
CELL:
E-MAIL:

YOUR APPLICATION(S) - PLEASE CHECK ALL THAT APPLY:
HEALTHCARE

	Med/Surge
	ICU/CCU
	Employee Health & Safety
	Emergency Department
	Emergency Preparedness
	EMS
	Other:

LABORATORY/BIO-MEDICAL

	Coroner
	Forensics
	Pathology
	Crime Scene Cleanup
	BSL-3
	Other:

NUCLEAR

Function:

PHARMACEUTICAL

Function:

INDUSTRIAL

	Powder coating
	Painting
	Woodworking
	Construction - specific area
	Food processing
	CAFO
	Other:

PRODUCT INFORMATION

DATE OF PURCHASE:
DISTRIBUTOR:
HELMET:	QTY:	SERIAL NUMBERS (separate by commas) Serial number is on blower label inside helmet top.
2070-03
2065-03
2025-03
New Purchase		Yes	Replacement purchase	Yes

BATTERY:	QTY:	LOT NUMBERS (separate by commas) Lot number is in upper right corner of clip side.
2000-30 (Large)
2000-36 (Small)
New Purchase		Yes	Replacement purchase	Yes

If you are registering multiple units please include all the serial numbers and lot numbers in the space provided above. For further Assistance please call Customer Service, 800-443-3842

2000-700 Cuff 710-DLC CAPR

MAXAIR PAPR Systems are powered air purifying respirators. The highly integrated, NIOSH PAPR configurations have reduced components and connections for greater reliability.

APPROVED

GSA CONTRACT NO.
GS-07F-0412U