Please return within 30 days of purchase
Name: ___________________________________________________________________
Address: __________________________________________________________________
City: _______________________ State: _____________ Zip Code :____________________
Phone : ___________________________ Email: __________________________________
Date Purchased: ____________________________________________________________
Would you like to receive a Brunton catalog? ( )Yes ( )No
Please let us know where you purchased your ROGER 18?
Store Name: _______________________________________________________________
City: _______________________ State: _______________ Zip Code: _________________
( ) Online site ______________________ ( ) Catalog ______________________________
( ) Gift ( ) Brunton ( ) Other _________________________________________________
Do you own another Brunton product?
( ) Yes. Product: ____________________________ ( ) No
Warranty Registration
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OGER 18
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eries
