Customer Referral Form

For every SUCCESSFUL customer referral to Puri Puri Anime Toys, you AND the person you referred will receive 5 reward points to redeem one of many prizes in our rewards program.
 (PLEASE NOTE:  Referral credits are given only after the first purchase order is complete on the new customer’s account.  Referrals must be redeemed within 60 days of submission of this form to be considered valid.)

Please fill in as much information as you can about each referral to ensure proper and timely credit to your account.
You may submit as many referrals as you wish.

Your Information
Name:
Address:
Address Cont:  
City  
State/Province  
Country  
Postal Code  
E-mail:
First Referral
Name:
Referred 1 Address:
Address Cont:  
City  
State/Province  
Country  
Postal Code  
E-mail:
Second Referral
Name:
Address:
Address Cont:  
City  
State/Province  
Country  
Postal Code  
E-mail:
Comments: