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About The Club Membership Club Benefits Experts Event
 
 
 
 
  First Name* :
 
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  Husband’s name :
 
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  Tel No. :
 
  Mobile No* :
 
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  Date of Birth :
   
 
 
  Whirlpool Appliance bought at enrolment
       
  REFRIGERATORS    
 
 
   
   
       
  WASHING MACHINE    
 
 
   
       
  AIR CONDITIONERS    
 
 
 
       
  MICROWAVE    
 
 
 
 
       
  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    
     
 
       
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