Product Registration Complete this form to register your Flushmate product. Product Registration General Name Required Email Required Phone Installation Details Type of Installation Required Select type Commercial Education Hospital & Healthcare Hotel & Hospitality Industrial / Manufacturing Office Building Residential (Single) Residential (Multi-family) Retail / Restaurant Other Company Name Required Street Address Required City Required State Required Select state Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip Code Required Country Required Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antigua & Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bonaire Bosnia & Herzegovina Botswana Brazil British Indian Ocean Ter Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Canary Islands Cape Verde Cayman Islands Central African Republic Chad Channel Islands Chile China Christmas Island Cocos Island Colombia Comoros Congo Cook Islands Costa Rica Cote DIvoire Croatia Cuba Curacao Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Ter Gabon Gambia Georgia Germany Ghana Gibraltar Great Britain Greece Greenland Grenada Guadeloupe Guam Guatemala Guinea Guyana Haiti Hawaii Honduras Hong Kong Hungary Iceland Indonesia India Iran Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Korea North Korea South Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macau Macedonia Madagascar Malaysia Malawi Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Midway Islands Moldova Monaco Mongolia Montserrat Morocco Mozambique Myanmar Nambia Nauru Nepal Netherland Antilles Netherlands (Holland, Europe) Nevis New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Norway Oman Pakistan Palau Island Palestine Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Island Poland Portugal Puerto Rico Qatar Republic of Montenegro Republic of Serbia Reunion Romania Russia Rwanda St Barthelemy St Eustatius St Helena St Kitts-Nevis St Lucia St Maarten St Pierre & Miquelon St Vincent & Grenadines Saipan Samoa Samoa American San Marino Sao Tome & Principe Saudi Arabia Senegal Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa Spain Sri Lanka Sudan Suriname Swaziland Sweden Switzerland Syria Tahiti Taiwan Tajikistan Tanzania Thailand Togo Tokelau Tonga Trinidad & Tobago Tunisia Turkey Turkmenistan Turks & Caicos Is Tuvalu Uganda United Kingdom Ukraine United Arab Emirates United States of America Uruguay Uzbekistan Vanuatu Vatican City State Venezuela Vietnam Virgin Islands (Brit) Virgin Islands (USA) Wake Island Wallis & Futana Is Yemen Zaire Zambia Zimbabwe Installation Date Required Number of Units Installed Required This toilet was installed by: Owner Plumber Other Flushmate Product Details Model Number Required Select model M-101525 (Two-piece) MA1010525 (Two-piece) M-101526 (Two-piece) MA101526 (Two-piece) M-101526-F (Two-piece) MA101526-F (Two-piece) M-101526-F3 (Two-piece) M-101526-F3H (Two-piece) M-101526-F4 (Two-piece) M-101526-FC (Two-piece) M-102540 (One-piece) M-102550 (One-piece) M-102540-F (One-piece) M-102540-F3 (One-piece) M-102540-F4 (One-piece) M-102540-C (One-piece) Serial Number Required How to find your model and serial number Add a Flushmate unit Where did you purchase this toilet or replacement Flushmate System? Required Select an option Contractor Home Center Kitchen & Bath Store Plumber Plumbing Store Remodeler Eflushmate.com Online Retailer Other Why did you purchase a new toilet or replacement Flushmate System? Required Select an option Renovating existing bathroom (New Toilet) New Construction (New Toilet) Replacing Toilet Only (New Toilet) Replacing Flushmate System (Existing Toilet) Other What sources did you use to select a new toilet? (Check all that apply) Flushmate.com Google Search Recommendation from friend / family Recommendation from Plumber / Contractor Kitchen & Bath Dealer Home Center Magazines Other Source Name Required