Registration Form
Thank you for your purchase of a Glo bulb for your aquarium. Your bulb will need to be replaced in 8-12 months, depending on usage, to maximize the effects on your fish and plant and maintain general aquarium benefits. We will remind you via email in 8 months and then follow up 60 days later.
The fields with a red ( * ) are required
  Sign up here for your reminder via email in 8 months and then follow up 60 days later.
  Title :
  First name : *
  Last name : *
  Address :*
  Address2 :*
  City :*
  County :*
  Postcode :*
  Country : * UK
  Telephone: *
  Email : *
  By providing your email address you allow Hagen to send you exciting offers and free samples of product. Hagen will never share your email address with other parties.
  Retype your email : *
  Age : *
  Sex : *
  Bulb Purchased : *
  
  Date installed :*
dd:  mm:  yy:
  Name of store where bulb was purchased:
  Location of store :
City / County
  Tank Size (litres)       Freshwater   Saltwater   Planted
  Fish types :
  Filter brand & model:
  Which brand of fish food do you use?
  Do you have any other pets? (please check off one or more):
              Bird(s)    
              Cat(s)    
              Dog(s)    
              Ferret(s)    
              Gerbil(s)    
              Hamster(s)  
              Rabbit(s)    
              Reptile(s)    
              I have a pond