Product Registration

First Name*

Last Name*

Address 1

Address 2

City

State

Zip

Email Address*

Gender*

Male Female

Age*

Date of Purchase* (mm/dd/yyyy)

Name of store/website where purchased

Price paid (excluding sales tax)

OPTIMA product purchased

Model

YellowTop
RedTop
BlueTop

Group Size

6V
25
27
31
34

34/78
35
51
72/25
78

Type of vehicle in which battery will be used:

Automobile/Truck
Boat/RV
Equipment (agricultural, construction, etc)
Other

Vehicle Make

Model

Year

Do you consider yourself an "enthusiast" for any of the following? (check all that apply)

Muscle Cars
Hot rods
Racing
Off-road
Drifting

Audio & Electronics
Diesel
Fishing
Wakeboarding
Leisure boating

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?

Longer life
Starting power
Vibration resistence
Maintenance-free
Mounting flexibility
Spill-proof
Product appearance
Warranty
Other (please specify)

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

I would like to receive e-mail news and updates from OPTIMA batteries

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

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