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Bowflex
Xceed MWarranty
Registration
Card
PLEASE PRINT CLEARLY - THANKYOU
[] Mr.
2. [] Mrs.
Name:
Address:
City:
Phone number:
E-Mail address:
3. [] Ms.
4. [] Miss
Customer ID from Invoice:
I _
J
State:
;
i
Apt. #:
Zip:
Is this your primary address? [] Yes
[] No
Place of purchase:
Date of purchase:
M
M
Purchaser date of birth:
Gender: []Male
[]Female
Y Y
D
D
D
M
Y Y
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
[] $15,000- $24,999
[] $35,000- $49,999
[] $75,000- $99,999
[] $100,000- $149,999
[] Over$150,000
What other types of exercise equipment do you own?
[]No
Did you receive this item as a gift? [] Yes
Name of original purchaser:
Original purchaser customer ID number:
0 Please check here if you would prefer notto obtain informationon new and interesting opportunities from other exciting companies.
Thanks for filling out this questionnaire. Your answers are important to us.
Costc(lBFX
Xceed OM FINAL91int.indd
79
8/16/2006
3:41:48 PM
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