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Register to Receive a Reminder
to Retreat Your Sewage System

By filling out the form below in one year from your date of purchase you will receive a postcard to remind you to treat your sewage system again.

This is not a proof of purchase form or a guaranteed registration, it only allows for the reminder postcard. Please be sure to keep your store receipt as proof of purchase.



Purchaser Information:
Name:
Street Address:
City:
State: Zip:
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Additional Information:
Product purchased:
Date of Purchase:
Cost of product:
Where product was purchased:



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