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Name *

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

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Light Model *

Argon 3"

Atom 3"

Quantum 6"

Titan

Retro R10

Retro R8

Retro R6

Retro T1

Retro N1

Date of Installation *

MM

DD

YYYY

Installed in a: *

Pool

Spa

Pool/Spa Construction Type: *

Concrete

Fiberglass

Vinyl

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By submitting this form I hereby agree to the terms and conditions of Spa electrics Pty Ltd Warranty Policy *

Yes, I Agree.