Macpherson Disconnection Confirmation

Macpherson Cup Holder

URGENT DISCONNECTION REQUIRED
DISCONNECTION CONFIRMATION

Please help confirm you have actioned disconnection of your Macpherson cup holders
Full Name:*

First NameLast Name
Focus On Furniture Invoice Number*
Please contact your local store if you need assistance to locate
Store of purchase*
Store suburb name
Phone Number
E-mail:*
I have disconnected all cup holders in my Macpherson suiteI require replacement Lumi-Cups and safety plugsI require assistance to disconnect cup holders
PLEASE INCLUDE ADDRESS INFORMATION BELOW IF YOU REQUIRE PARTS OR ASSISTANCE
Current Address

Street Address

Street Address Line 2

CityState

Zip CodeCountry
QTY of cup holders required?
QTY of safety plugs required?
Comments or Questions:
Signature*

Clear
Should be Empty:

Macpherson Cup Holder