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MICROPHASE COATINGS, INC. Product Registration

Thank you " . $Fname . "$nbsp" . $Lname . " for registering your " . $Product . "!  

Your Registeration code is  " . $Email . ""; else echo "This page is designed to allow our customers to get a product registration code, which is vital in order to claim any type of warrantee. Our system is set up to use your email address as your warrantee reference code. So please use an email that you will be keeping and make sure to save the next page! "; ?>
  Personal Information:
  First Name:   Middle Name:   Last Name:
  Address 1:   Address 2:   City:
  State:   Zip Code:   Country:
  Email Address:   Home Phone:   Cell Phone:

  Product Information:
  Product:   Product Lot #:   Purchased From:
  Purchase Date:   Purchase Price:      

  Application Information:
  Application Date:   Applied By:*   Method of Application:
  Surface Applied On:            

* Please list the name of the Certified PhaseCoat® applicator.

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©2007 MICROPHASE COATINGS, INC. 3916 Yateswood Ct. Raleigh, NC 27603. All Rights Reserved Worldwide.

Specializing in Hydrophobic, Super Hydrophobic, Icephobic, Thermal Barrier, Foul Release, Non-Fouling, Anti-Corrosion, Anti-icing, Non-Stick, Poly-Urea, Silane, Silicone, Polysiloxane, Epoxy and other specialty coatings and products.

Products include: PhaseBrite, PhaseBreak, Correz, CorrBlock, ThermaBlock.