All registrants will be entered into a monthly drawing. A valid email address and pump serial number are required to receive the monthly prize. Winners will be notified by email. Good luck!
* required field
First Name: *
Last Name: *
E-mail: *
Company Name: *
Industry:
Address line 1: *
Address line 2:
City: *
State / Province (US & CAN): *
If "other" for state:
Postal/Zip Code: *
Country: *
Phone Number: *
Approximate date the pump was put into service (MM/DD/YYYY): *
Source where pump was purchased:
Name of company where purchased:
Are you satisfied with your purchase?
Would you recommend Versa-Matic to others?
Type of pump being replaced:
Brand of pump being replaced:
What benefit MOST made you choose a Versa-Matic pump?
You can register up to three pumps below. If additional are needed, please use an additional instance of this form.
Serial Number: *
Model Number: *
Serial Number:
Model Number:
Serial Number:
Model Number:
Comments:
