Bowflex Bowflex Xceed Warranty Registration Card, IMPORTANT! Mail Within 30 Days of Purchase

Bowflex Xceed™ Warranty Registration Card

IMPORTANT! MAIL WITHIN 30 DAYS OF PURCHASE

PLEASE PRINT CLEARLY – THANK YOU

 Mr. 2.  Mrs. 3.  Ms. 4.  Miss Customer ID from Invoice:

Name:

Address:

City:

Phone number:	(
E-Mail address:

)

-

EXT.

State:

Apt. #:

Zip:

Is this your primary address?  Yes			 No
Place of purchase:
Date of purchase:
	M	M	D	D	Y	Y

Purchaser date of birth:

M M

D D

Y Y

Gender:  Male	 Female
Marital status:	 Married	 Single
Including yourself, total number of people living in your household: (Examples: 01, 02, 03 …)
Would you like to receive additional information on healthy lifestyle products?  Yes  No
Which best describes your family income: (US dollar figures)
 Under $15,000	 $25,000 – $34,999		 $50,000 – $74,999	 $100,000 – $149,999
 $15,000 – $24,999		 $35,000 – $49,999	 $75,000 – $99,999		 Over $150,000

What other types of exercise equipment do you own?

Did you receive this item as a gift?  Yes  No

Name of original purchaser:

Original purchaser customer ID number:

Please check here if you would prefer not to obtain information on new and interesting opportunities from other exciting companies.

Thanks for filling out this questionnaire. Your answers are important to us.

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