Alloys Claim Form
Please take your time to fill out the following form. We have prefilled some of the fields with information from your records. You may edit the values in these fields prior to submitting the form.
* denotes a field which is compulsory.

Company Details:
Please enter your company details so we can contact you in future regarding specials and promotions applicable to your business.
Company Code *
Company Name *
Company Address *
Suburb *
State *
Post Code * *Please insert 4 value only
Phone *
Email *

Promotion Details:
Please enter the details of the promotion you are claiming for.
Promotion Description *
Product Purchased *
Invoice No *
Purchase Date * (dd/mm/yyyy)

Recipient Details:
Please enter the individual's details to receive the bonus promotional offer. Please note this form must be signed by managment to be valid. Bonus offers to be sent at the end of the promotional period.
First Name *
Last Name *
Address * Tick if the address is same as above.
Suburb *
State *
Postcode * *Please insert 4 value only
Owner/Mgr. First Name *
Owner/Mgr. Last Name *

    I hereby confirm that I am duly authorised to represent the above mentioned company in receving and claiming marketing incentives from Alloys.

    Alloys Promotion Terms and conditions:

  1. Alloys reserve the right to change incorrect prices/ specifications resulting from printing or typographical errors.
  2. Any FBT liability incurred for bonus items obtained through this promotion is entirely the responsibility of the Winner / Purchaser.
  3. Any disputes over unsuccessful claims must be raised with 14 days of the end of the promotion.
  4. No cash alternative offered.

I agree to the terms and conditions stated above.

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