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Earn a FREE T-shirt!
Patch of the Month

How the Program Works

To receive a FREE T-shirt in the PowerPatch® Patch of the Month program, print this page, fill out the form fully, and send it with a picture of your completed work and a short description of your repair to:

Or email the information and jpeg files to PowerPatch@polywater.com. Note that your photo(s) may be used by American Polywater in promotion of PowerPatch® Transformer Leak Repair Sealant. Please be sure to specify your shirt size.

Name: _____________________________________________________________________

Company: __________________________________________________________________

Title: ______________________________________________________________________

Mailing Address: _____________________________________________________________

Shipping Address: ____________________________________________________________

City: _____________________________________ State: ___________ Zip ______________

Phone: ________________________________ Email: _______________________________

Shirt Size (S,M,L,XL,XXL): _______________________________

Describe the repair that you made with PowerPatch®: ___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

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