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The form below is for registering your new MIC-D Digital Microscope. If you have already filled out and mailed your product registration card, you do not need to use this form.
Personal Information
Mr. Mrs. Ms. Dr.
First Name:
 M. Initial:
 Last Name:
Company:
 Title:
Address: (Number and Street)
 Address 2:

City:
 State:
 Zip:
Phone Number:
( ) - - 		Fax Number:
( ) - -
Email Address:
 Re-enter Email Address:
 
Check here if we may contact you to get your feedback or to inform you of new products. Please check all communication options that you would prefer.
Email     Phone     Fax     Mail

Purchase Information
Model Number:
 Serial Number:
Date of Purchase: (ex: March/25/2000)
/ /
Dealer product was purchased from:


1. How did you hear about the MIC-D?
  Browsing our website
  Magazine    
  Colleague/Friend
  Sales Rep
  Tradeshow
  Other          
2. How do you plan on using your MIC-D?
  Hobbyist/Personal use
  Classroom Education
  Semiconductor/Industrial
  Other           
 

Your privacy is a priority to us.
At Olympus, it is our obligation to you as a valuable customer to protect the trust you have placed in us, including safeguarding any information you share on this questionnaire. Occasionally, we work with other reputable companies that manufacture products that we think might be interesting to you. Many of our customers find these offers helpful. However, if you would prefer not to receive promotional offers from other companies, please let us know by simply checking the box.


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