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Bowflex
PLEASE PRINT CLEARLY – THANK YOU
Mr.
2. Mrs.
3. Ms.
Name:
Address:
City:
(
Phone number:
E-Mail address:
Is this your primary address?
Place of purchase:
Date of purchase:
M M
Purchaser date of birth:
Gender:
Male
Female
Marital status:
Married
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?
Which best describes your family income: (US dollar figures)
Under $15,000
$15,000 – $24,999
What other types of exercise equipment do you own?
Did you receive this item as a gift?
Name of original purchaser:
Original purchaser customer ID number:
Thanks for filling out this questionnaire. Your answers are important to us. Please check here
not to obtain information on new and interesting opportunities from other exciting companies.
© 2006, Nautilus Inc. All Rights Reserved. 16400 SE Nautilus Dr., Vancouver, Washington, USA 98683. Bowflex, Blaze, Power Rod and the Bowflex and Nautilus logos are either registered
trademarks or trademarks of Nautilus Inc.
Blaze
Home Gym Warranty Registration Card
®
™
IMPORTANT! MAIL WITHIN 30 DAYS OF PURCHASE
4.
Miss
)
-
Yes
No
D D
D D
M M
Single
$25,000 – $34,999
$35,000 – $49,999
Yes
No
Customer ID from Invoice
EXT.
Y Y
Yes
$50,000 – $74,999
$75,000 – $99,999
Apt. #:
State:
Zip:
No
$100,000 – $149,999
Over $150,000
if you would prefer
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