Name: ______________________________________________________________
Address: ____________________________________________________________
City: _______________________ State: ___________ Zip: ___________________
Phone: _____________________Email:___________________________________
Date Purchased: ______________________________________________________
Amount Paid: ________________________________________________________
Would you like to receive a Brunton Catalog? ( )Yes ( )No
Which SolarRoll model did you purchase? ( )14 ( )9 ( )4.5
Please let us know where you purchased your SolarRoll:
Store Name: ________________________
City: _______________________ State: ___________ Zip: ___________________
( ) On-Line site _________________ ( ) Catalog _________________________
( ) Gift
( ) Brunton
( ) Other ___________________________
Do you own another Brunton Product?
( ) Yes. Product: _____________________________ ( ) No.
I purchased the Brunton SolarRoll primarily to power or charge my...
( ) Satellite Phone ( ) Digital Camera
( ) Video Camera
( ) Laptop ( ) Vehicle Battery
( ) Other___________________
( ) Small TV ( ) Cell Phone
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Warranty Registration
