FUJIFILM X SERIES CASH BACK

To claim your cash back, please fill in the details below.

Applicable to qualifying purchases between 16th October 2017 and ending 7th January 2018.

Your Details:  
Title *
First Name *
Last Name *
Address *
Suburb/Town/City *
Phone *
Phone number must be 10 digits
E-mail *
 
Payment:  
I would like to be paid by:
 
BSB Number *
Account Number *
Name of Bank
 
Store Details:  
Supplier *
Supplier Suburb *
 
Product Details  
Product Purchased *  
Product Serial Number *  
Date of Purchase *  
Proof of Purchase *
 
Receipt can’t be larger than 2MB.
 
 
 
 
Terms and Conditions (click here for Term and Conditions).
 
* mandatory information