By submitting the information, we can confirm the date of purchase of your product. Please note the purchase receipt together with our local warranty card stating the clause ‘6 months additional warranty for on-line registration’ has to be produced for warranty repair.
1. Name and address:
Mr Mrs. Ms. Dr  
Name
Address
 Tel no
Email Address
2. Please enter the details of the model you're registering:
   
Model
 Serial number
Date purchased
dd/mm/yy
Dealers Name
Dealers Address
3. Please enter the components of the GXR camera that you purchased. For the lens, please add in the serial number as well.
GXR Body Yes No  
Ricoh S10 Lens No
GR Lens A12 No
4. Your profile:
Male Female
 
5. Was the camera you purchased:
6. In Question 5, if you selected option 2 or 3 please indicate which model was replaced.
7. Where did you buy your camera?
 
8. Did you compare camera model prior to your purchase? If so, would you please indicate which model?
Brand
 Model
9. How did you learn about our product?
* Select at least 1 response and no more than 3 responses. 
 
10. Which features or functions made you to purchase your camera?
* Select at least 5 responses. 
 
11. From the previous question, please select the most important item in selecting your camera?
12. Please list the name of 3 magazines you often read.
1. 2. 3.
13. Indicate the URL (address) of the 3 most popular websites which you visit.
1.  2. 3.
14. When do you use the camera?
* Select at least 3 responses. 
 
 
 
15. How often do you carry your digital camera?
 
16. Which features are important for your next digital camera?
* Select at least 6 responses. 
 
   
 
 
I have read the Warranty Terms and Conditions
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To clear the form, press this button: