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Please use the Manage Form Option to Develop your Form

Name*		Surname*	Country*
Date of Birth		Physical Address*	State
E-mail Address*		Contact Number*	Do you wish to receive E-mail updates and newsletters about MagnaPool's latest promotions and news? Yes No
MagnaPool Installation Date*	How many hours per day are you running your hydroxinator for?*	Who installed your MagnaPool?*	How did you hear about MagnaPool?*
Which aspect of a MagnaPool appeals to you the most? The Health & Beauty Benefits The Environmental Benefits The Technology No Chlorine Smell Water Clarity The Energy-Saving Other	What percentage output registers on the screen daily?*	What is your average income bracket?*	If Magazine or Newspaper Please Name
		Do you have any children?*	If 'OTHER' Please specify
If 'OTHER' Please Specify		Which Age category do you fall into?*	Please enter your customer number given to you by your pool builder to qualify to recieve your Detox and Relaxation Gift (If you have not received your gift certificate please contact your builder)
Privacy Terms & Conditions Magnapool Corporation Pty Ltd ACN 075 273 004 (Magnapool) is committed to complying with the Privacy Act 1988 (Cth) and the National Privacy Principles. By signing this order form you consent to and authorise Magnapool to collect, use and disclose your personal information, whether directly or by someone else. Magnapool may disclose your personal information to Poolrite Equipment Pty Ltd ACN 010 846 714 (Poolrite), any related bodies corporate of Magnapool and Poolrite, and any licensed retailers, distributors and agents of Magnapool products to provide you with better products and services, on-going support, updates and information. Magnapool will not disclose your personal information to another person or entity without your consent. You can access and amend your personal information held by Magnapool at any time by email to [EMAIL]. Only you personally will be able to access your information. Please refer to Magnapool's Privacy Policy at www.magnapool.com for more details on how Magnapool deals with and protects your personal information.
I agree with the Privacy Terms & Conditions

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