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Sterling VA La-Z-Boy Furniture Galleries
21320 Signal Hill Plaza
Sterling, VA 20164
571-434-7687
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Product Registration

1. Name & Address:

Title:*

First Name:*

MI:

Last Name:*

Street:*

Apt. No.:

City:*

State/Province:*

Zip/Postal Code:*

E-Mail Address:*

2. Date of Birth:

3. Marital Status:

Married

Single

4. Date of Purchase:

5. ALI (Ack-Line-Item):

(The ALI number may be obtained from the Product
Identification Label which is attached to the unit.
Example: 0606301111-001-001)

6. Style Number:

7. Cover Number (Example: CD 801222 or D 801222):

8. Please indicate where you purchased this product:

La-Z-Boy Furniture Galleries

Department store (name)

Local Furniture Store (name)

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Failure to submit this registration will not diminish your warranty rights.

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