Bowflex 3.1 Bench Assembly & Owners Manual page 13

Bowflex
®
PLEASE PRINT CLEARLY – THANK YOU
 Mr. 2.  Mrs. 3.  Ms.
Name:
Address:
City:
(
Phone number:
E-Mail address:
Is this your primary address?  Yes
Place of purchase:
Date of purchase:
M M
Purchaser date of birth:
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
 $15,000 – $24,999
What other types of exercise equipment do you own?
Did you receive this item as a gift?  Yes
Name of original purchaser:
Original purchaser customer ID number:
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SelectTech 3.1 Bench Warranty Regstraton Card
®
IMPORTANT! MAIL WITHIN 30 DAYS OF PURCHASE
4.  Miss
)
-
 No
D D
Y Y
D D Y Y
M M
 $35,000 – $49,999
 No
Thanks for filling out this questionnaire. Your answers are important to us.
Customer ID from Invoice:
EXT.
 $50,000 – $74,999
 $75,000 – $99,999
Apt. #:
State: Zip:
 $100,000 – $149,999
 Over $150,000