Diamondback 06.DB SS OM manual Price paid

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If you do not have access to a computer, please complete the form below and return within the next 10 days.*Notates required fields.

Date of				* What is your bike’s
Purchase:					model year?
Month	Day		Year
What model bike do you have?			*
Della Cruz		Della Cruz 1.0			Grind
Impression		Joker		Jr Viper	Lil’ Della Cruz
Mini Impression		Mini Viper		Miz Della Cruz	Mr. Lucky
Mr. Lucky 24		Nitrus		Orion	RM 12
RM 16		RM 20		Session	Sherman
Skin Dog		Venom		Viper	Viper X
Other (specify)
What is your bike’s serial number?			(see diagram on inside front cover for location)

Purchased from (dealer name)?

Dealer’s	Price paid	$	0 0
state:	(excluding sales tax) :
Reasons you purchased a Diamondback:
Received as a gift	Advertisement		Prior experience with brand
Color/Appearance	Frame/Design/Materials		Component selection
Quality/Durability	Family/Friend Recommendation		Weight of bicycle
Comfort/Fit	Value/Price		Sales person’s recommendation
Diamondback’s Reputation	Other

Other brands considered ?

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First Name:

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Last Name:

Date of birth:

Month DayYear

Gender:	Male	Female
Marital status:	Married	Single

Email

Address:

Street	Street & Apt No.
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Address:
	City
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	Zip Code
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Annual	Under $20,000
Income:	$20,000 – $50,000
	$50,000 – $75,000

You	Spouse
Occupation	Professional/Technical
(Check all	Upper Management/Executive
that apply) :
	Middle Management
	Sales/Marketing
	Retired

Middle

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$75,000 – $100,000

Over $100,000

You Spouse

Clerical/Service Worker

Tradesman/Machine Operator/Laborer

Student

Housewife