Free Convertible Top Program Participation Request

Thank you for your interest in participating in our Free Convertible Top Program. Robbins is pleased to produce and install a convertible top free of charge for individuals who meet our requirements. Please complete the form below:

Name:

Address:

City:

State:

Zip Code:

Email Address:

Year, Make, Model of Convertible:

	I agree to allow Robbins Auto Top, LLC to use my vehicle to test fit convertible tops and/or other products as part of their new product development program. I certify that I am the owner of the vehicle I have noted above and my vehicle meets the eligability requirements of the program, documented at http://www.robbinsautotopco.com/freetops.php. I agree to deliver my vehicle to Robbins' plant at 321 Todd Court, Oxnard, CA 93030 and leave it for a period of 3 to 7 days where it will be used to fit test convertible tops and/or other products. Robbins will confirm the specific time frame when providing the schedule for me to deliver the vehicle. In the event the agreed upon time frame must be exceeded, Robbins will notify me in advance of the last day of the scheduled period. I agree to allow Robbins employees and contracted installer to test drive my vehicle as part of the product test fitting process. I agree to allow Robbins to photograph my vehicle and use the images in advertising, brochures, catalogs, website, and/or other means of Robbins product promotion, without receiving compensation over or above the convertible top to be provided through this Free Convertible Top Program.

Your Name:
	(Use "Print" button below to print a copy for your records before you submit the form)
		Clear all form data: