TotalGuard
Please fill out the form below in order to register your product. Use the sample receipt on the right as a guide in filling out this form. NOTE: The information will be provided to the TotalGuard Plan administrator. All fields with an asterisk (*) are required.
Date of Purchase *
Store Number *
Terminal Number *
Transaction Number *
Plan Number *
First Name * M.I. 
Last Name *
Address 1 *
Address 2
City: *
Province *
Postal Code * (XXX XXX)
Phone * ( )    Ext.
Alternate Phone ( )    Ext.
E-mail Address
Product Number *
 (on receipt)
Manufacturer *
Product Category *
Product Category (Other)
Model Number
Serial Number
Product Purchase Amount *
 Excluding Taxes