PURCHASER

Name and Surname : (required)

Address: (required)

City: (required)

Zip code: (required)

Email: (required)

HELMET FEATURES

Model reference: (required)

Color: (required)

Size: (required)
--- XXXS XXS XS S M L XL XXL

Homologation Number: (required)
(Es: E3012345/P 012345) The number is on the ticket sewn to your chin-strap

INFORMATION ON THE PURCHASE

Date of purchase: (required)

Store/dealer: (required)

Invoice Number/Ticket Receipt Number: (required)

Amount paid for the helmet: (required)

1. Why did you choose a PREMIER helmet?

--- Graphics e Design Quality Comfort Advertisement and magazines Recommended by the dealer Brand Safety Competitive price Have you owned a Premier helmet before Recommended by a friend Other

Other:

2. What helmet did you use before purchasing a PREMIER helmet?

Other:

3. What type of motorcycle do you ride?

11. Help us improve our product with your suggestions!

Conforming to the Italian law n. 196 of Giune 30th 2003, I hereby explicity authorise the use of my personal data. (Civil Code for the Protection of Personal Privacy)

I authorize:

I do not authorize: