Earlex Product Registration

Please complete the Product Registration form below and you will be automatically entered into a prize draw to win an Earlex product of your choice.

Title	Mr Mrs Miss Ms
Name *
Address 1 *
Address 2
Address 3
Postcode *
Email *
* Please ensure this information is completed

Model Name
Date of Purchase	Day Month Year (e.g. 2007)

1. What type of store was the product purchased from?
Homebase	Focus
Screwfix	Mail Order
Argos	Machine Mart
Wickes	Other (please state)

2. How did you learn about this product?
Store display	Brochure
Mail order catalogue	Newspaper
Friend/relative	Other (please state)
Magazine

3. Which factor most influenced your choice of an Earlex product?
Product features	Brand/reputation
Price	Quality

4. If you have purchased an HVLP, where do you intend to use it?
Interior walls or ceilings	Decking
Radiators	Doors
Spindles	Other (please state)
Fences

5. Age group
18 - 24	44 - 54
25 - 34	55 - 64
35 - 44	65 +

6. Gender
Male	Female

6. Please tick below if you would like to:
Receive Earlex news & offers	Participate in Earlex research

	Please enter the security word displayed here If you can't read the word, click here Word *:

Click here to view our Privacy Statement

Click here for Prize Draw Rules and Terms and Conditions