WARRANTY
Please complete and return this product warranty card or register your product online
at: backtobasicsproducts.com within 10 days of purchase.
THIS INFORMATION IS FOR INTERNAL USE ONLY
Mr. | Mrs. | Ms. | Model: Cocoa~Latte Express™ |
1.Name __________________________________________________________________
2.Address _________________________________________________________________
City ______________________________________ State ______ Zip Code _____
3.
4. | Age: |
| 50+ | |||
5. | Marital Status: | Married |
| Single |
| |
6.Number of Children in the House : 12 yrs and under _________
7.Income: 
Below $25,000 
$75,001+
8.Where was this product purchased? ___________________________________________
9.How did you become aware of this product?
____ Gift | ____ Recommendation from friend |
____ TV advertisement | ____ Saw product in store |
____ Print ad | ____ TV shopping program |
____ Magazine article | ____ Internet |
| ____ Other ________________________ |
10. What were the two most important reasons infl uencing your purchase:
____ Gift | ____ Recommended by sales person |
____ Special offer | ____ Recommended by friend |
____ Product appearance | ____ Prior experience with Back to Basics |
____ Ease of operation | ____ Back to Basics brand reputation |
____ Quality/durability | ____ Value for price |
____ Product features | ____ Product packaging |
| ____ Other ________________________ |
11. Why did you purchase this Back to Basics product?
____ To replacement/upgrade current product
____ Not satisfi ed with current product(s) already owned
____ First product(s) ever owned
____ Received as a gift
12. Would you be interested in being contacted via
product information, etc.? 
YES
NO
COMMENTS _______________________________________________________________________
