Test-Warranty

Last Name
First Name
Street Address
City
State/Province
Country
ZIP/Postal Code
Email Address
May we contact you by email with product updates, announcements or future product surveys?	Yes No
Date of Purchase	mm/dd/yyyy
Select the SeaLife Product Purchased
If item is not shown above, enter SL item # and product name.
Enter serial number(s) for each major product purchased: Camera (bottom of inner camera) UW Housing (inside UW housing) Light/Flash (inside battery compartment) Lens (side of lens – some lenses may not have SN)
Select the type of store this product was purchased in
Enter name of Merchant
Enter Price Paid (in US Dollars excluding Sales Tax)
Select the type of diver you consider yourself to be
Select where you first learned about SeaLife
Select where you've seen a SeaLife Advertisement
Select your age
Select future items you intend to purchase (do not include any items already purchased)
Select how many years you have been a certified diver
Select how many diving trips you have taken in the last 12 months?	None 1 2 3 to 5 6 or more
Select how many times you traveled by airplane to go diving or snorkeling in the last 12 months?	None 1-2 3 or more
Select for which activities you will use your SeaLife equipment
Select which best describes your annual household income
Select areas where you went diving in the last 12 months
Select where you got more detailed product information
Prove you aren't a robot:	1 + 9 = ?

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