All fields with an Asterisk are required

After completing this form, you will receive your Unique Access Code for you to claim your free gift from Pirelli.

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* 1. First Name

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* 2. Surname

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* 3. Email Address

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* 4. Street address and number

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* 5. Suburb or Town

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* 7. Postcode

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* 8. Mobile Phone

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* 9. What brand (and tread pattern) were your previous tyres?

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* 10. Make, model and year of manufacture of your vehicle

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* 11. Date of purchase of your 4 Pirelli Cinturato or Scorpion tyres

Purchase completed on:

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* 12. Please select the tread pattern you purchased

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* 13. Tyre store or website your tyres were purchased from

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* 14. Click here to attach a copy of your purchase invoice

DOCX, DOC, JPEG, GIF, JPG, PDF, PNG file types only.
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* 15. Terms & Conditions

T