Name*:

Surname:

Contact details

Phone*:

Email*:

Mailing address

Address*:

City:

State*: Please select New South Wales Australian Capital Territory Northern Territory Queensland South Australia Tasmania Victoria Western Australia

Postcode*:

Fridge details

Brand*:

Model number*:

Type*: Please select Upright Fridge/Freezer Upright Fridge Upright Freezer Upside down Fridge/Freezer Chest Freezer Bar Fridge Bar Freezer Other

Top door seal

Top seal width:

Top seal length:

Bottom door seal

Bottom seal width:

Bottom seal length:

Fridge seal colour

Seal colour*: Please select Grey (Light) Grey (Dark) White Black Brown

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