Title
Ms      Mr      Company     
Company name

Last Name *

First name *

E-mail *

Phone *

Mobile phone

Street and number *

Postal code *

City *

Country * - Switzerland Belgium Germany France Netherlands - Andorra United Arab Emirates Afghanistan Antigua and Barbuda Anguilla Albania Armenia Netherlands Antilles Angola Antarctica Argentina American Samoa Austria Australia Aruba Azerbaijan Bosnia and Herzegovina Barbados Bangladesh Belgium Burkina Faso Bulgaria Bahrain Burundi Benin Bermuda Brunei Bolivia Brazil The Bahamas Bhutan Bouvet Island Botswana Belarus Belize Canada Cocos (Keeling) Islands Congo Central African Republic Congo-Brazzaville Switzerland Côte d’Ivoire Cook Islands Chile Cameroon China Colombia Costa Rica Cuba Cape Verde Christmas Island Cyprus Czech Republic Germany Djibouti Denmark Dominica Dominican Republic Algeria Ecuador Estonia Egypt Western Sahara Eritrea Spain Ethiopia Finland Fiji Falkland Islands Micronesia Faroes France Gabon United Kingdom Grenada Georgia French Guiana Ghana Gibraltar Greenland Gambia Guinea Guadeloupe Equatorial Guinea Greece South Georgia and the South Sandwich Islands Guatemala Guam Guinea-Bissau Guyana Hong Kong SAR of China Honduras Croatia Haiti Hungary Indonesia Ireland Israel India British Indian Ocean Territory Iraq Iran Iceland Italy Jamaica Jordan Japan Kenya Kyrgyzstan Cambodia Kiribati Comoros Saint Kitts and Nevis North Korea South Korea Kuwait Cayman Islands Kazakhstan Laos Lebanon Saint Lucia Liechtenstein Sri Lanka Liberia Lesotho Lithuania Luxembourg Latvia Libya Morocco Monaco Moldova Madagascar Marshall Islands Macedonia Mali Myanmar Mongolia Macao SAR of China Northern Marianas Martinique Mauritania Montserrat Malta Mauritius Maldives Malawi Mexico Malaysia Mozambique Namibia New Caledonia Niger Norfolk Island Nigeria Nicaragua Netherlands Norway Nepal Nauru Niue New Zealand Oman Panama Peru French Polynesia Papua New Guinea Philippines Pakistan Poland Saint Pierre and Miquelon Pitcairn Islands Puerto Rico Portugal Palau Paraguay Qatar Reunion Romania Russia Rwanda Saudi Arabia Solomon Islands Seychelles Sudan Sweden Singapore Saint Helena Slovenia Svalbard Slovakia Sierra Leone San Marino Senegal Somalia Suriname São Tomé e Pr�ncipe El Salvador Syria Swaziland Turks and Caicos Islands Chad French Southern Territories Togo Thailand Tajikistan Tokelau Turkmenistan Tunisia Tonga Timor-Leste Turkey Trinidad and Tobago Tuvalu Taiwan Tanzania Ukraine Uganda United States Minor Outlying Islands United States Uruguay Uzbekistan Vatican City Saint Vincent and the Grenadines Venezuela British Virgin Islands US Virgin Islands Vietnam Vanuatu Wallis and Futuna Samoa Yemen Mayotte South Africa Zambia Zimbabwe Palestine Serbia and Montenegro Aland Islands Heard Island and McDonald Islands
Birth date (dd/mm/yyyy)

Correspondance language
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No.

Your product

Serial number of your product (under your product) * (ex. 123456/123456)

Choose your product ----MAGIC i-S6PROSPRINTSTEAMUP G4STEAMUP i-G5STEAMUP VERTSTEAMYSWISSMAID EVOLUTIONPREMIUMPREMIUM EVOLUTIONPREMIUM EVOLUTION IIPREMIUM NMAGIC i-S5PREMIUM S3STEAMAX – STEAMAX LTDSTEAMAX G2COMPACTFIRSTFIRST G1MAGICMAGIC EVOLUTIONMAGIC EVOLUTION IIMAGIC S4MAGIC VERT
Other products (Serial number)

Product purchase

Store name

City

Purchase date

Complementary informations

Number of people in your household

Reason of purchase

gift	brand reputation
price/promotion	seller's advice
friend's advice	advertising
following a demonstration	other

Brand name & model of your former ironing system

Type of your former ironing system
 Iron  Steam station  System  Other

Number of ironing hours per week

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