PLEASE FILL OUT AND RETURN WITHIN THE NEXT IO DAYS. Please write all information legibly.
1. Customer Information
Mr. Mrs. Ms. Miss
First Name Initial Last Name
Street Apt. No
City State Zip
Phone Email Address
2. Date of Purchase: Month Day Year
3. Product Information:
Tribest®Personal Blender®Model #: Serial #:
4. Dealer Information
Dealer Name
Dealer Address
Phone
Tribest®Personal Blender®
REGISTRATION FORM
• How did you learn of Tribest BPA Free Personal Blender? (Please check only one.)
Received as a gift Magazine advertisement Newspaper advertisement
TV advertisement Radio advertisement In-store display or demo
Consumer magazine article Friend's recommendation Salesperson
Information through the mail Other
• What is your primary residence?
Own a House Own a Townhouse or Condo Rent a House
Rent an Apartment,Townhouse or Condominium
• What is your Annual Household Income?
Less than $15,000 $15,000-$25,000 $25,000-$50,000
$50,000-$75,000 $75,000-$100,000 more than $100,000
• What factors most influenced your decision to purchase this blender? (please check up to three)
Tribest PB reputation Style and appearance Value for the price
Special product features Warranty Rebate or sale price
Quality and durability Consumer Magazine Article Reputation of the Dealer
Friend Recommendation Salesperson Other
• What is your occupation?
Homemaker Professional/Technical Upper Management or Executive
Middle Management Sales/Marketing Clerical or Service Worker
Self Employed/Business Owner Student Retired
Tradesman/Machine Operator/Laborer
• Which credit cards do you use regularly?
Visa MasterCard American Express
Discover Department Store Diner's Club
Gasoline Company, etc. Do not use credit cards
put glue here to seal
OPTIONAL SURVEY
