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Personal Details
Title:
Please Select
Mr.
Mrs.
First Name:
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Last Name:
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Address 1:
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City:
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Postal Code:
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Country:
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Switzerland
Mobile Number:
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E-mail Address:
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Confirm E-mail Address:
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Payment Method
Payment Method
*
Wire Transfer
Revolut
Bank Transfer Details
Account holder's profile type:
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Please Select
Individual
IBAN:
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SWIFT:
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Beneficiary name:
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Enter full names of the beneficiary of the account as per passport/identity card (without initials and title).
Beneficiary name:
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Enter full names of the beneficiary of the account as per passport/identity card (without initials and title).
Revolut Details
Account holder's profile type:
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Please Select
Individual
Revtag
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To check your
Revtag
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'Profile'
by tapping your profile picture in the top left corner.
Beneficiary name:
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Please provide the name as it appears on your Revolut account.
Beneficiary name:
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Please provide the name as it appears on your Revolut account.
Product Details
Number of products purchased:
1
2
3
4
5
Product 1:
*
Please Select
Freecom 2X DUO
Freecom 4X DUO
Packtalk EDGE DUO
Packtalk NEO DUO
Packtalk PRO
SPIRIT HD DUO
Serial No 1:
*
Serial No 2 1:
*
*for DUO pack only, for PACKTALK PRO single, please input the same serial number twice
Date of Purchase 1:
*
DD/MM/YYYY
Purchase Price 1:
*
Store & City 1:
*
Please Select
3W Motosport
aplusmoto SA
BADAN MOTOS
Bixe AG
Brechbühl 2-Rad AG
Cardo Systems Online
Chevalier motos Sàrl
Daytona Shop S.A.
FMC Flon Moto Centre Sàrl
FREERIDE
FSB Moto Shop SA
Galaxus.ch
GDK Motos Sarl
Geri Handels AG
Harley Aargau
Harley-Davidson Basel AG
Hobby Moto
HOBI MOTO AG
HOLZER MOTOS AG
Louis Etoy
louis-moto.ch
Louis Root
Louis Wallisellen
Mäge Motos GmbH
MB MOTO MODE SA
MGD Distribution SA
Moto 91 AG
Moto-Boutique-Peseux SA
MOTO-CENTER BERN
Moto Center Schwyz AG
MOTO-CENTER THUN
MOTO CENTER WEST AG
Motoevasion SA
MOTO LINE
Moto Mader AG
MOTOSHOP 46 AG
Motos Knüsel GmbH
Motosport Genève
MOTOSROCHAT SA
Motowelt 24
MSK MotoShop Kollbrunn GmbH
N & O Bike AG
Paradize Moto SA
Polo CH-Bern
Polo CH-Etoy-YD
Polo CH-Horgen
Polo CH-Oftringen
Polo CH-St.Gallen
Polo CH-Villeneuve
polo-motorrad.com
POLO Store Etoy (205)
POLO Store Horgen (201)
POLO Store Niederwangen (202)
POLO Store Oftringen (203)
POLO Store St. Gallen (204)
POLO Store Villeneuve (206)
Racepoint AG
RPS GmbH
Schlatter Motorräder AG
Targiroff Moto-Center AG
Töff-Bekleidung Ipsach AG
Töff-Bekleidung Swiss Uster
Töff-Total! Boutique GmbH
Trimoto SA
Zwei-Rad-Sport Elgg
Other Store
Store Name Other 1
*
Please submit your proof of purchase 1:
*
Product 2:
*
Please Select
Freecom 2X DUO
Freecom 4X DUO
Packtalk EDGE DUO
Packtalk NEO DUO
Packtalk PRO
SPIRIT HD DUO
Serial No 2:
*
Serial No 2 2:
*
*for DUO pack only, for PACKTALK PRO single, please input the same serial number twice
Date of Purchase 2:
*
DD/MM/YYYY
Purchase Price 2:
*
Store & City 2:
*
Please Select
3W Motosport
aplusmoto SA
BADAN MOTOS
Bixe AG
Brechbühl 2-Rad AG
Cardo Systems Online
Chevalier motos Sàrl
Daytona Shop S.A.
FMC Flon Moto Centre Sàrl
FREERIDE
FSB Moto Shop SA
Galaxus.ch
GDK Motos Sarl
Geri Handels AG
Harley Aargau
Harley-Davidson Basel AG
Hobby Moto
HOBI MOTO AG
HOLZER MOTOS AG
Louis Etoy
louis-moto.ch
Louis Root
Louis Wallisellen
Mäge Motos GmbH
MB MOTO MODE SA
MGD Distribution SA
Moto 91 AG
Moto-Boutique-Peseux SA
MOTO-CENTER BERN
Moto Center Schwyz AG
MOTO-CENTER THUN
MOTO CENTER WEST AG
Motoevasion SA
MOTO LINE
Moto Mader AG
MOTOSHOP 46 AG
Motos Knüsel GmbH
Motosport Genève
MOTOSROCHAT SA
Motowelt 24
MSK MotoShop Kollbrunn GmbH
N & O Bike AG
Paradize Moto SA
Polo CH-Bern
Polo CH-Etoy-YD
Polo CH-Horgen
Polo CH-Oftringen
Polo CH-St.Gallen
Polo CH-Villeneuve
polo-motorrad.com
POLO Store Etoy (205)
POLO Store Horgen (201)
POLO Store Niederwangen (202)
POLO Store Oftringen (203)
POLO Store St. Gallen (204)
POLO Store Villeneuve (206)
Racepoint AG
RPS GmbH
Schlatter Motorräder AG
Targiroff Moto-Center AG
Töff-Bekleidung Ipsach AG
Töff-Bekleidung Swiss Uster
Töff-Total! Boutique GmbH
Trimoto SA
Zwei-Rad-Sport Elgg
Other Store
Store Name Other 2
*
Please submit your proof of purchase 2:
*
Product 3:
*
Please Select
Freecom 2X DUO
Freecom 4X DUO
Packtalk EDGE DUO
Packtalk NEO DUO
Packtalk PRO
SPIRIT HD DUO
Serial No 3:
*
Serial No 2 3:
*
*for DUO pack only, for PACKTALK PRO single, please input the same serial number twice
Date of Purchase 3:
*
DD/MM/YYYY
Purchase Price 3:
*
Store & City 3:
*
Please Select
3W Motosport
aplusmoto SA
BADAN MOTOS
Bixe AG
Brechbühl 2-Rad AG
Cardo Systems Online
Chevalier motos Sàrl
Daytona Shop S.A.
FMC Flon Moto Centre Sàrl
FREERIDE
FSB Moto Shop SA
Galaxus.ch
GDK Motos Sarl
Geri Handels AG
Harley Aargau
Harley-Davidson Basel AG
Hobby Moto
HOBI MOTO AG
HOLZER MOTOS AG
Louis Etoy
louis-moto.ch
Louis Root
Louis Wallisellen
Mäge Motos GmbH
MB MOTO MODE SA
MGD Distribution SA
Moto 91 AG
Moto-Boutique-Peseux SA
MOTO-CENTER BERN
Moto Center Schwyz AG
MOTO-CENTER THUN
MOTO CENTER WEST AG
Motoevasion SA
MOTO LINE
Moto Mader AG
MOTOSHOP 46 AG
Motos Knüsel GmbH
Motosport Genève
MOTOSROCHAT SA
Motowelt 24
MSK MotoShop Kollbrunn GmbH
N & O Bike AG
Paradize Moto SA
Polo CH-Bern
Polo CH-Etoy-YD
Polo CH-Horgen
Polo CH-Oftringen
Polo CH-St.Gallen
Polo CH-Villeneuve
polo-motorrad.com
POLO Store Etoy (205)
POLO Store Horgen (201)
POLO Store Niederwangen (202)
POLO Store Oftringen (203)
POLO Store St. Gallen (204)
POLO Store Villeneuve (206)
Racepoint AG
RPS GmbH
Schlatter Motorräder AG
Targiroff Moto-Center AG
Töff-Bekleidung Ipsach AG
Töff-Bekleidung Swiss Uster
Töff-Total! Boutique GmbH
Trimoto SA
Zwei-Rad-Sport Elgg
Other Store
Store Name Other 3
*
Please submit your proof of purchase 3:
*
Product 4:
*
Please Select
Freecom 2X DUO
Freecom 4X DUO
Packtalk EDGE DUO
Packtalk NEO DUO
Packtalk PRO
SPIRIT HD DUO
Serial No 4:
*
Serial No 2 4:
*
*for DUO pack only, for PACKTALK PRO single, please input the same serial number twice
Date of Purchase 4:
*
DD/MM/YYYY
Purchase Price 4:
*
Store & City 4:
*
Please Select
3W Motosport
aplusmoto SA
BADAN MOTOS
Bixe AG
Brechbühl 2-Rad AG
Cardo Systems Online
Chevalier motos Sàrl
Daytona Shop S.A.
FMC Flon Moto Centre Sàrl
FREERIDE
FSB Moto Shop SA
Galaxus.ch
GDK Motos Sarl
Geri Handels AG
Harley Aargau
Harley-Davidson Basel AG
Hobby Moto
HOBI MOTO AG
HOLZER MOTOS AG
Louis Etoy
louis-moto.ch
Louis Root
Louis Wallisellen
Mäge Motos GmbH
MB MOTO MODE SA
MGD Distribution SA
Moto 91 AG
Moto-Boutique-Peseux SA
MOTO-CENTER BERN
Moto Center Schwyz AG
MOTO-CENTER THUN
MOTO CENTER WEST AG
Motoevasion SA
MOTO LINE
Moto Mader AG
MOTOSHOP 46 AG
Motos Knüsel GmbH
Motosport Genève
MOTOSROCHAT SA
Motowelt 24
MSK MotoShop Kollbrunn GmbH
N & O Bike AG
Paradize Moto SA
Polo CH-Bern
Polo CH-Etoy-YD
Polo CH-Horgen
Polo CH-Oftringen
Polo CH-St.Gallen
Polo CH-Villeneuve
polo-motorrad.com
POLO Store Etoy (205)
POLO Store Horgen (201)
POLO Store Niederwangen (202)
POLO Store Oftringen (203)
POLO Store St. Gallen (204)
POLO Store Villeneuve (206)
Racepoint AG
RPS GmbH
Schlatter Motorräder AG
Targiroff Moto-Center AG
Töff-Bekleidung Ipsach AG
Töff-Bekleidung Swiss Uster
Töff-Total! Boutique GmbH
Trimoto SA
Zwei-Rad-Sport Elgg
Other Store
Store Name Other 4
*
Please submit your proof of purchase 4:
*
Product 5:
*
Please Select
Freecom 2X DUO
Freecom 4X DUO
Packtalk EDGE DUO
Packtalk NEO DUO
Packtalk PRO
SPIRIT HD DUO
Serial No 5:
*
Serial No 2 5:
*
*for DUO pack only, for PACKTALK PRO single, please input the same serial number twice
Date of Purchase 5:
*
DD/MM/YYYY
Purchase Price 5:
*
Store & City 5:
*
Please Select
3W Motosport
aplusmoto SA
BADAN MOTOS
Bixe AG
Brechbühl 2-Rad AG
Cardo Systems Online
Chevalier motos Sàrl
Daytona Shop S.A.
FMC Flon Moto Centre Sàrl
FREERIDE
FSB Moto Shop SA
Galaxus.ch
GDK Motos Sarl
Geri Handels AG
Harley Aargau
Harley-Davidson Basel AG
Hobby Moto
HOBI MOTO AG
HOLZER MOTOS AG
Louis Etoy
louis-moto.ch
Louis Root
Louis Wallisellen
Mäge Motos GmbH
MB MOTO MODE SA
MGD Distribution SA
Moto 91 AG
Moto-Boutique-Peseux SA
MOTO-CENTER BERN
Moto Center Schwyz AG
MOTO-CENTER THUN
MOTO CENTER WEST AG
Motoevasion SA
MOTO LINE
Moto Mader AG
MOTOSHOP 46 AG
Motos Knüsel GmbH
Motosport Genève
MOTOSROCHAT SA
Motowelt 24
MSK MotoShop Kollbrunn GmbH
N & O Bike AG
Paradize Moto SA
Polo CH-Bern
Polo CH-Etoy-YD
Polo CH-Horgen
Polo CH-Oftringen
Polo CH-St.Gallen
Polo CH-Villeneuve
polo-motorrad.com
POLO Store Etoy (205)
POLO Store Horgen (201)
POLO Store Niederwangen (202)
POLO Store Oftringen (203)
POLO Store St. Gallen (204)
POLO Store Villeneuve (206)
Racepoint AG
RPS GmbH
Schlatter Motorräder AG
Targiroff Moto-Center AG
Töff-Bekleidung Ipsach AG
Töff-Bekleidung Swiss Uster
Töff-Total! Boutique GmbH
Trimoto SA
Zwei-Rad-Sport Elgg
Other Store
Store Name Other 5
*
Please submit your proof of purchase 5:
*
Where did you find out about our promotion ?
Social Media
Print Magazine
E-newsletter/ Emailer from Retailers
In Store : Poster, Display , other marketing materials
Store Staff
From friends or family
Others:
Which brand intercom have you used before?
I haven’t used intercom before
Cardo
Sena
Midland
Interphone
Other brands
Did this cashback promotion speed up your buying decision?
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NO
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of this promotion.
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