Release Form for Customer Testimonials

Terms

Agreement *

I agree with the above terms.

Contact Info

First Name *

Last Name *

Title *

Organization *

Street Address *

City *

State/Province *

ZIP/Postal Code *

Phone Number *

E-mail Address *

Details

Testimonial / Success Story *

CAPTCHA

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Share your success stories with using the Fernco family of products (StormDrain, Wax-Free Toilet Seal, Pow-R Products, PlumbQwik and QwikSeal).

If your story is selected to be featured on our website we will send you our Limited Edition Fernco Poker Chip set as a token of our appreciation for submitting your story.