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* 2. First Name

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* 3. Surname

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* 4. Email Address

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* 5. Street address and number

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* 6. Suburb or Town

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* 8. Postcode

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* 9. Mobile Phone

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* 10. Date of purchase of 4 GT Radial or Giti 4WD or SUV tyres

Date

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* 11. GT Radial or Giti Dealer Name

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* 12. GT Radial or Giti Dealer Location

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* 13. Click here to attach a copy of your receipt

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* 14. Terms & Conditions

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* 15. GT Radial & Giti news & specials offers by email or SMS

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