Bruno Product Registration Form

Bruno Product Registration Form

Bruno is now pleased to offer the option of returning product registration forms electronically, rather than having to fill them out by hand. Please be assured that Bruno does not share or sell the information you provide. Please note that all fields marked with a red asterisk (*) are required. Also, this online form is not to be used for registering the Lift-Up™ Power Mobility Seat - please use the paper form that came with the product.

*First Name:
Middle Initial:
*Last Name:
*Street Address:
Apartment #:
*City:
*State/Province:
*Zip/Postal Code:
Email Address:
Telephone #:
Date of Purchase:		(please enter as mm/dd/yy)
Model Number:
*Serial Number:

Please rate your satisfaction with your Bruno dealer:

excellent

good

average

poor

Please rate your satisfaction with your Bruno product:

excellent

good

average

poor

Bruno reserves the right to use the information indicated on this form in its online, video, audio and printed materials. Names will be abbreviated to ensure the privacy and anonymity of the individual.