Buy 4 Pirelli Dragon Sport or Cinturato P7 tyres in the same transaction, complete this form and receive a $100 Westfield XS eftpos gift card!

All fields with an Asterisk are required

Question Title

* 1. First Name

Question Title

* 2. Surname

Question Title

* 3. Email Address

Question Title

* 4. Street address and number

Question Title

* 5. Suburb or Town

Question Title

* 6. State

Question Title

* 7. Postcode

Question Title

* 8. Mobile Phone

Question Title

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

Question Title

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

Make

Model

Year

Question Title

* 11. Date of purchase of your 4 Pirelli Dragon Sport or Cinturato P7 tyres

Purchase completed on:

Date

Question Title

* 12. Please select the tread pattern you purchased

Question Title

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

Question Title

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

(uploading a clear photo from your phone is acceptable)

DOCX, DOC, JPEG, GIF, JPG, PDF, PNG file types only.

Question Title

* 15. Terms & Conditions

Click here to accept terms & conditions.