Warranty Registration

(*) Required Fields
Your Information:
*First Name:	*Last Name:
*Email:
*Phone:
*Date of Birth:

Your Mailing Address:
*Address:
*City:	* *ZIP:
*Country:

Street Address of your Goalrilla Unit (where unit is installed):
Same As Above:
*Address:
*City:	* *ZIP:
*Country:

Your Goalrilla Information:
*Which unit did you purchase?
*Serial Number:	(Located in the middle on the backside of the pole for basketball goals.)

Where did you purchase your Goalrilla system?
*Dealer Name:
*Dealer City:
*Dealer Country:

Price paid for your Goalrilla:	(excluding installation)
Did you purchase any accessories?	Deluxe Hoop Light Hoop Light Deluxe Pole Pad Ultimate Pole Pad Backboard Pads

Please help us learn more about Goalrilla owners
by answering the following questions:

Number of residents in your household?

# of Males:
Under 9 years
10-14 years
15-17 years
18-20 years
21-29 years
30-39 years
40 years and older

# of Females
Under 9 years
10-14 years
15-17 years
18-20 years
21-29 years
30-39 years
40 years and older

How did you learn about Goalrilla?

How often will your Goalrilla system be used?

What is your annual household income?

What magazines do you or
your family read regularly?

What websites do you or
your family visit regularly?

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