PURCHASER'S INFORMATION

Purchaser's Name: *
Address: *
City: *
State: *		- State - AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY - ZIP Code: * (5 or 9 digits)
Email Address:*		- Home Telephone:
Date of Purchase:*		- Date of Installation:
Installed By: *		Vehicle Owner Place of Purchase

PLACE OF PURCHASE

Business or Internet Name: *
Address:
City:
State:		- State - AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY - ZIP Code:    (5 or 9 digits)
ICI Product Part#: *		- Purchase Price (Excluding taxes):

VEHICLE INFORMATION

Year, Make, Model of Vehicle: *

PRODUCT BEING REGISTERED

Product Name/Type: *		Stainless or ABS Rocker Panel Kit 3 Inch Round Stainless or Black Nerf Bars 4 Inch Round Stainless or Black Nerf Bars 4 Inch Oval Stainless Nerf Bars Stainless or ABS Accessory Stainless Tube Side Rails Stainless or Treadbright Bed Rail Caps U-Cut Product

COMPLETING YOUR WARRANTY SUBMISSION

• this Online Form or
• Fax to 623-486-3886 or
• Mail to:
  ICI / Innovative Creations, Inc.
  7733 W. Seldon Lane
  Peoria, Arizona 85345.

Thank you for your purchase!