form test – Anaheim Marketing International

form testami2019-03-04T21:34:13+00:00

Product Registration Form

Name*
First Last
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Email*
Phone*
Select Your Product*
- Food Waste Disposer
- UV-C Air Sanitizer
- Ready Hot® Dispenser
- Precision RO® Reverse Osmosis System
- Water Chiller
Date of Purchase*
Date Format: DD dash MM dash YYYY

The date you purchased your product. Should match the receipt.
Serial Number is Required for Disposer Registration

Find the S/N on the bottom of the disposer or the cord tag for most brands.
Brand Name and Model Number*
Place of Purchase*
Upload Receipt
Accepted file types: gif, png, jpg, jpeg, pdf.
(We recommend you staple your original receipt to your manual for future use.) Receipts are required for Warranty inquiries. We are not responsible for unforeseen digital errors in retaining uploaded receipts.
OPTIONAL REMINDERS
- Time To Replace Your UV-C Lamp (recommended-once a year notice)
- Holiday Sales
CAPTCHA

Happy St. Patrick's Day from Mr. Scrappy - Save 10% Off Your Cart Today!

Happy St. Patrick’s Day [%first_name | Default Value%]!

We want to keep the Good Luck going with this $Green$ Gift.

10 PERCENT off Your Entire Cart

Save on Disposer Accessories like the Mr. Scrappy Disposer Tool

10% Off the Disposer Brush

10% Off our entire Disposer stock

Ready for that Ready Hot® - Grab it with 10% Off

Save 10% on Replacement Parts

10% OFF YOUR ENTIRE CART

Discount applies to Sale Items too! But, just like a rainbow… it will soon disappear. Use Coupon Code: GreenDay (valid through 3/20/19)

REPLACEMENT PARTS

Sink Flange Assembly

Splashguard & Stopper

3-Bolt Mount Assembly

CUSTOM COLOR SINK FLANGES

Oil Rubbed Bronze

MR. SCRAPPY ACCESSORIES

Wireless Control Switch

Mr. Scrappy® Tool

[Sender_Name]

[Sender_Address], [Sender_City], [Sender_State] [Sender_Zip]

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