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First Name*
:
Last Name*
:
Name as required on membership card*
:
Husband’s name
:
Address*
:
City *
:
Pin
:
Tel No.
:
Mobile No*
:
Email *
:
Date of Birth *
:
Whirlpool Appliance bought at enrolment
REFRIGERATORS
450 LTR PROFESSIONAL DLX
450 LTR PROFESSIONAL ELITE
410 LTR PROFESSIONAL DLX
410 LTR PROFESSIONAL ELITE
WASHING MACHINE
650 H
800 H
Dryers
AWZ 320 GD
AIR CONDITIONERS
2 TON SPLIT
1.5 TON SPLIT PREMIER
1.5 TON SPLIT ROYALE
1 TON SPLIT
MICROWAVE
MAGICOOK 22C
MAGICOOK 25C
MAGICOOK 30C
MAGICOOK JT 355
MAGICOOK JT 359
Date of purchase*
:
Cash memo no *
:
FRIEND 1
FRIEND 2
First Name *
Last Name*
Address*
City *
PIN*
Tel
Mobile*
First Name
Last Name
Address
City
PIN
Tel
Mobile
*Fields are mandatory
Whirlpool India website
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