Product Registration

First Name*

Last Name*

Address 1

Address 2

City

State

Zip/Postal

Email Address*

Gender*

Male Female

Age*

Date of Purchase* (mm/dd/yyyy)

Name of store/website where purchased

Price paid (excluding sales tax)

Model

YellowTop
RedTop
BlueTop
Digital 1200 Battery Charger

Type of vehicle in which your product will be used:

Vehicle Make

Model

Year

How did you first become aware of OPTIMA?

Friend/relative's recommendation
Salesperson's recommendation
Television advertisement
Magazine advertisement/article
Online research
Store display
Store circular/flyer
Events (racing, fishing, etc)
Other (please specify)

What were the most important features that influenced your selection of this product?

Are there any other vehicles in your household with an OPTIMA battery?

Yes No

Vehicle Make

Model

Year

This purchase was:

First time buying an OPTIMA
A replacement for another OPTIMA
An additional OPTIMA product

Sign-up for OPTIMA's Power Pack Nation online enthusiast community for access to exclusive information and other free member benefits: http://powerpacknation.optimabatteries.com/start_signup.html?1292947498

Registering your OPTIMA product does not function as proof of purchase. For warranty purposes, you must keep your receipt.