REGISTRATION FORM

The following fields must be completed in full for the warranty to be validated, including your warranty number and activation code for the products applied. Please refer to the Terms & Conditions page for the full warranty details.

CUSTOMER INFORMATION

FIRST NAME *

LAST NAME *

ADDRESS *

TOWN / SUBURB *

STATE *

POST CODE *

PHONE *

EMAIL *

VEHICLE IDENTIFICATION

MAKE *

YEAR *

MODEL*

COLOUR *

REGISTRATION *

VIN / CHASSIS NUMBER *

MILEAGE *

VEHICLE LESS THAN 12 MONTHS OLD? *

Yes

WARRANTY REGISTRATION

OPTI-COAT DEALER*

APPLICATION DATE *

WARRANTY NUMBER *

ACTIVATION CODE *

Required fields are missing!

Terms & Conditions Car Care

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