Brother Product Registration
First Name | Last Name |
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Company Name |
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Address
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CityStateZip Code
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Telephone Number | Model Number |
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Fax Number | Serial Number |
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Store Where Purchased | Purchase Date ( MM - DD - YYYY ) |
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1.How did you first become aware of this Brother product?
(Please Write in ONE Choice in the box to the left)
6.Which best describes your occupation?
(Please Write in ONE Choice in the box to the left)
! | A. | Magazine Advertisement | F. | Friend / Relative |
B. | Newspaper | G. | Dealer / Store Display | |
C. | TV Advertisement | H. | Business Associate | |
| D. | Radio Advertisement | I. | Brochure |
| E. | Brother Website / Internet | J. | Other |
2.What other Brother products do you own or have you purchased in the past?
(Please Write in top 3 choices in the boxes to the left)
! | A. | Business Owner | G. | Sales / Marketing |
B. | Clerical / Service | H. | Student | |
C. | Homemaker | I. | Teacher / Professor | |
| D. | Management | J. | Tradesman / Laborer |
E.Professional / Technical K. Other
F.Retired
7.Which Hobbies do you enjoy?
(Please Write in top 3 choices in the boxes to the left)
!!! | A. | Embroidery Machine | F. | Printer |
B. | Fax Machine | G. | Sewing Machine | |
C. | Label Maker | H. | Stamp Creator | |
| D. | Laminator | I. | Typewriter |
| E. | Multifunction |
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3.Which of the following factors influenced your decision to buy this product?
(Please Write in top 3 choices in the boxes to the left)
!!! | A. | Advertisement | G. | Size / Weight |
B. | Brother’s Reputation | H. | Store Flyer / Display | |
C. | Ease of Use | I. | Styling / Appearance | |
| D. | Features | J. | Quality / Reliability |
| E. | Friend / Relative | K. | Warranty |
| F. | Price / Value | L. | Other |
4.Please Select the Primary use for this product?
(Please Write in ONE Choice in the box to the left)
! | A. | Business Use ( 1 - 5 Employees) | ||
B. | ( 6 - 19 Employees) | F. | (500 and Over) | |
C. | ( 20 - 49 Employees) | G. | Personal Use | |
| D. | ( 50 - 99 Employees) | H. | Student Use |
| E. | ( 100 - 499 Employees) | I. | Other |
5.Which of the folowing best matches your age group?
(Please Write in ONE Choice in the box to the left)
! | A. | 18 - 24 | D. | 46 - 55 |
B. | 25 - 35 | E. | 56 - 64 | |
C. | 36 - 45 | F. | 65 and over |
!!! | A. | Arts / Antiques | F. | Gardening | K. | Sewing |
B. | Cooking | G. | Internet / PC | L. | Sports | |
C. | Crafts | H. | Music | M. | Travel | |
| D. | Decorating | I. | Photography | N. | Other |
| E. | Electronics | J. | Reading |
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8.Which of the following magazines / publications do you read regularly?
(Please Write in top 3 choices in the boxes to the left)
!!! | A. | Business Week | F. | Newsweek / Time |
B. | Computer Shopper | G. | PC Magazine | |
C. | Consumer Reports | H. | PC World | |
| D. | Forbes / Fortune | I. | C/Net (Online) |
| E. | Macworld / Mac Home | J. | Other |
Would you like to receive Brother information regarding?
Special offers, rebates and discounts? | @YES | @NO |
New software, drivers and service related updates? | @YES | @NO |
Newsletters and surveys? | @YES | @NO |
Website updates and enhancements? | @YES | @NO |
Please make sure you FILL in your choices completely.
To view our privacy policy, go to www.registermybrother.com
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