IMPORTANT! Mail Within 30 Days of Purchase

Bowflex® SelectTech® 3.1 Bench Warranty Registration Card

 Mr.

2.  Mrs.

3.  Ms.

4.  Miss

Customer ID from Invoice:

Name:

Address:

City:

)

EXT.

State:

Apt. #:

Zip:

Is this your primary address?  Yes

 No

Place of purchase:

Date of purchase:

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:

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