U.S. Para Plate Promotions

Buy Three, Get a Winter Hat Free!

Need to Purchase More? Find a Distributor

Instructions

1. Purchase any three U.S. Para Plate products before February 28, 2011.
2. Fill in the form below and click SUBMIT.
3. You will receive your free U.S. Para Plate hat in the mail within 2 - 3 weeks.

* First Name:

* Last Name:

* Company:

* Telephone:

* Email:

* Address 1:

Address 2:

* City:

* State:

* Zip:

Country:

*Please list the three U.S. Para Plate products that you purchased and indicate the purchase price and date:

	Product	Price	Date of Purchase (MM/DD/YY)
1
2
3

* From which Dealer/Supplier did you buy these products?

* Please specify the type of systems that you own. Please check all that apply:

Self-Service Car Wash

In-Bay Automatic Car Wash

Express Tunnel Car Wash

Truck Wash

Dog Wash

Vacuums

Carpet Cleaning

Water Treatment

Industrial Process

Other

Which U.S. Para Plate product do you purchase most frequently?

Are there any new products or product improvements that you would like to see?

Your feedback is important to us. Please let us know if you have any other comments:

I certify that the above is true and the purchase can be verified.