Bowflex SelectTech 3.1 Bench - Manual (Page 13)

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