Referral Reward Program

1. BASIC INFORMATION

NAME (required)

ADDRESS (required)

CITY (required)

TOWN (required)

STATE (required)

TELEPHONES NOS: (required)

EMAIL (required)

2. PATRONAGE HISTORY

What XplosionControl product(s) have you bought before?

A.
Product Type (required)

Product Quantity (required)

Date of Purchase (required)

Serial No. (required)

B.
Product Type

Product Quantity

Date of Purchase

Serial No.

C.
Product Type

Product Quantity

Date of Purchase

Serial No.

D.
Product Type

Product Quantity

Date of Purchase

Serial No.

E.
Product Type

Product Quantity

Date of Purchase

Serial No.

F.
Product Type

Product Quantity

Date of Purchase

Serial No.

G.
Product Type

Product Quantity

Date of Purchase

Serial No.

Product Type

Product Quantity

Date of Purchase

Serial No.

3. What has been your general deployment experience (REQUIRED)

4. Reward Candy Receipt Preference (REQUIRED)

4.1 If Bank Transfer, please submit account details:

Program Terms: All referral reward applicants are to NOTE as follows:

a. Referral reward candy is limited to 5% of initial cost of product purchased (and fully paid for) to be credited to the account of the Referrer (the person whose referral code was used to process the order by the customer that paid for the purchase).

b. If end user (customer that paid for the purchase) did not include Referrer’s code on the customer order form then no candy can be credited to any Referrer

c. A valid Referral purchase will entitle the end user customer to 5% discount on product cost only

d. Referral Reward Candy calculation credit does not include items such as storage charge, shipment charge, installation fee, accessory cost, repair charge etc. It is only the initial product cost that is used for the calculation.

e. The decision of Supply Chain Global Services Ltd. on candy benefit/reward is FINALand shall be binding on all parties concerned.

Note:

Half completed or poorly completed forms cannot be processed.