Professional Technician and Consumer Sweepstakes

Official Entry Form

Complete The Information Below to Be Entered In the Sweepstakes Drawings

Entry Information

  • Country   United States Flag ImageCanada Flag Image
  • Serial Code  
    Brake Promo Scratch Off Card

  • Date Sold
  • Part Number
  • Invoice Number
  • Who is your supplier of
    Perfect Stop/Wagner?

Entrant Information

  • First Name
  • Last Name
  • Home Address (No PO Boxes)
  • Home City
  • Home State
  • Home Zip
  • Email
  • Home Phone

Store/Shop Information

  • Store/Shop Name
  • Store/Shop Address (No PO Boxes)
  • Store/Shop City
  • Store/Shop State
  • Store/Shop Zip
  • Store/Shop Phone
  • Servicing Parts Store (Technicians Only)

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Purchase a Set of Perfect Stop or ThermoQuiet® Brake Pads
and receive a chance to WIN one of TWO Harleys.
Harley Davidson 1200 Sportster Perfect Stop Ceramic Brake Pads Thermo Quiet Brake Pads