Registration Form
Thank you for your purchase of 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 :
Mr.
Mrs.
Miss
Ms.
Dr.
First name :
*
Last name :
*
Address :
*
Apartment :
City :
*
State :
*
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
Washington, D.C.
West Virginia
Wisconsin
Wyoming
Zip :
*
Country :
*
USA
Telephone:
*
-
-
Email :
*
By providing your email address you allow Rolf C. Hagen (USA) Corp. to send you exciting offers and free samples of product. Rolf C. Hagen (USA) Corp. will never share your email address with other parties.
Retype your email :
*
Age :
*
14-25
26-35
36-55
55+
Sex :
*
F
M
Bulb(s) Purchased :
*
Aqua~Glo Fluorescent Aquarium Bulb, 14 Watt - 15"
Aqua~Glo Fluorescent Aquarium Bulb, 15 Watt - 18"
Aqua~Glo Fluorescent Aquarium Bulb, 20 Watt - 24"
Aqua~Glo Fluorescent Aquarium Bulb, 25 Watt - 30"
Aqua~Glo Fluorescent Aquarium Bulb, 30 Watt - 36"
Aqua~Glo Fluorescent Aquarium Bulb, 40 Watt - 42"
Aqua~Glo Fluorescent Aquarium Bulb, 40 Watt - 48"
Aqua~Glo Fluorescent Aquarium Bulb, 8 Watt - 12"
Flora~Glo Fluorescent Aquarium Bulb, 15 Watt - 18"
Flora~Glo Fluorescent Aquarium Bulb, 20 Watt - 24"
Flora~Glo Fluorescent Aquarium Bulb, 25 Watt - 30"
Flora~Glo Fluorescent Aquarium Bulb, 30 Watt - 36"
Flora~Glo Fluorescent Aquarium Bulb, 40 Watt - 42"
Flora~Glo Fluorescent Aquarium Bulb, 40 Watt - 48"
Life-Glo T5 HO Fluorescent Bulb 24W - 22"
Life-Glo T5 HO Fluorescent Bulb 39W - 34"
Life-Glo T5 HO Fluorescent Bulb 54W - 46"
Life~Glo Fluorescent Aquarium Bulb, 15 Watt - 18"
Life~Glo Fluorescent Aquarium Bulb, 20 Watt - 24"
Life~Glo Fluorescent Aquarium Bulb, 25 Watt - 30"
Life~Glo Fluorescent Aquarium Bulb, 30 Watt - 36"
Life~Glo Fluorescent Aquarium Bulb, 40 Watt - 42"
Life~Glo Fluorescent Aquarium Bulb, 40 Watt - 48"
Life~Glo II Fluorescent Aquarium Bulb, 14 Watt - 15"
Life~Glo II Fluorescent Aquarium Bulb, 15 Watt - 18"
Life~Glo II Fluorescent Aquarium Bulb, 20 Watt - 24"
Life~Glo II Fluorescent Aquarium Bulb, 25 Watt - 30"
Life~Glo II Fluorescent Aquarium Bulb, 30 Watt - 36"
Life~Glo II Fluorescent Aquarium Bulb, 40 Watt - 42"
Life~Glo II Fluorescent Aquarium Bulb, 40 Watt - 48"
Marine-Glo T5 HO Fluorescent Bulb 24W - 22"
Marine-Glo T5 HO Fluorescent Bulb 39W - 34"
Marine-Glo T5 HO Fluorescent Bulb 54W - 46"
Marine~Glo Fluorescent Aquarium Bulb, 15 Watt - 18"
Marine~Glo Fluorescent Aquarium Bulb, 20 Watt - 24"
Marine~Glo Fluorescent Aquarium Bulb, 25 Watt - 30"
Marine~Glo Fluorescent Aquarium Bulb, 30 Watt - 36"
Marine~Glo Fluorescent Aquarium Bulb, 40 Watt - 42"
Marine~Glo Fluorescent Aquarium Bulb, 40 Watt - 48"
Power-Glo T5 HO Fluorescent Bulb 24W - 22"
Power-Glo T5 HO Fluorescent Bulb 39W - 34"
Power-Glo T5 HO Fluorescent Bulb 54W - 46"
Power~Glo Fluorescent Aquarium Bulb, 14 Watt - 15"
Power~Glo Fluorescent Aquarium Bulb, 15 Watt - 18"
Power~Glo Fluorescent Aquarium Bulb, 20 Watt - 24"
Power~Glo Fluorescent Aquarium Bulb, 25 Watt - 30"
Power~Glo Fluorescent Aquarium Bulb, 30 Watt - 36"
Power~Glo Fluorescent Aquarium Bulb, 40 Watt - 42"
Power~Glo Fluorescent Aquarium Bulb, 40 Watt - 48"
Power~Glo Fluorescent Aquarium Bulb, 65 Watt - 60"
Power~Glo Fluorescent Aquarium Bulb, 8 Watt - 12"
Sun~Glo Fluorescent Aquarium Bulb, 14 Watt - 15"
Sun~Glo Fluorescent Aquarium Bulb, 15 Watt - 18"
Sun~Glo Fluorescent Aquarium Bulb, 20 Watt - 24"
Sun~Glo Fluorescent Aquarium Bulb, 25 Watt - 30"
Sun~Glo Fluorescent Aquarium Bulb, 30 Watt - 36"
Sun~Glo Fluorescent Aquarium Bulb, 40 Watt - 42"
Sun~Glo Fluorescent Aquarium Bulb, 40 Watt - 48"
Sun~Glo Fluorescent Aquarium Bulb, 8 Watt - 12"
Date installed :
*
dd:
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
mm:
1
2
3
4
5
6
7
8
9
10
11
12
yy:
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
Name of store where bulb was purchased:
Location of store :
City / State
Tank Size (Gallons)
- 5 gal
6 - 8 gal
9 - 12 gal
13 - 20 gal
21 - 30 gal
31 - 40 gal
41 - 50 gal
51 - 65 gal
66 - 80 gal
86 - 100 gal
101 + gal
Freshwater
Saltwater
Planted
Fish types :
Filter type :
Which brand of fish food do you use?
Check box if you want to receive coupons:
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
Occasionally Hagen will be releasing product and other information. (by Email)
Check box if you would you like to be updated on:
Newsletter :
Press release :