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* = Required / Requise |
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| * MUSICmiles Member Number: |
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| * Email address: |
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| * Dealer name: |
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| * Dealer address: |
* Dealer Province: |
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| * Date of purchase: |
* Invoice number: |
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| MUSICmiles can only be collected on eligible purchases made after the date you registered with the MUSICmiles programme. |
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| * Description of purchase: |
* Purchase Price: |
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$
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| Total spent on Yamaha products before taxes |
| Please specify model numbers and quantities purchased |
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| * Source of funds: |
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Please specify "other" source of funds |
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