First Name
Last Name
Who are you?
Electrician/Installer
Homeowner
Facilities Manager
Other
Phone Number
Email
Address
City
Post Code
Is the premises a commercial or domestic environment?
Domestic
Commercial
Company (if applicable)
Date of Purchase
Date of Installation
Product Code
Quantity
Batch Code or Date Code
Comments
I agree to provide my personal information to Leviton for use in accordance with its
Privacy Policy
. *
For California residents only. In accordance with the CCPA, I understand that I may be providing the following Categories of Personal Information (as defined in the CCPA) to Leviton by completing this form: Identifiers, Commercial Information, and Internet or other similar network activity, for the purpose of fullfilling my request.
By submitting this form, I certify that the information I have provided is true.
I have read and understand the Warranty
Terms and Conditions
. *
I have read and understand Leviton's
Privacy Policy
. *