Product Registration

bromic / companion product registration

This form will serve as a record of where and when you purchased your product. Please keep your proof of purchase receipt or invoice in a safe place. All compulsory fields marked with a red asterisk (*).

PRIVACY POLICY:
Your details will not be passed onto any third parties. Bromic will use these details strictly for sales and marketing purposes and use your feedback/suggestions to better serve customer needs.

CONTACT DETAILS
*NAME:
COMPANY NAME:
*ADDRESS:
*SUBURB:
*STATE:
*POST CODE:
*PHONE:	Please include area code
MOBILE:
FAX:	Please include area code
*E-MAIL:
*Would you like to receive information about new products and specials? Yes No
PURCHASE / PRODUCT DETAILS
*MODEL NUMBER:
SERIAL NUMBER:
PRICE (incl. GST): $
*DATE OF PURCHASE:	/ /
*PLACE OF PURCHASE:
*SUBURB OF PURCHASE:
*STATE OF PURCHASE:
CHECK ANY OF THE FOLLOWING FACTORS THAT PROMPTED THE PURCHASE OF YOUR PRODUCT: NEWSPAPER/MAGAZINE ADVERTISING TELEVISION/RADIO ADVERTISING PRODUCT FEATURES BRAND REPUTATION PRICE / SPECIAL SALE SALESPERSONS RECOMMENDATION FRIENDS RECOMMENDATION PREVIOUS EXPERIENCE WITH A SIMILAR PRODUCT STORE DISPLAY BROCHURE
COMMENTS / SUGGESTIONS :