*
Required Fields - All fields are required except Fax
number.
|
| *
Model Name: |
*
Serial Number:
|
| *
Purchase Date: (eg: 01/10/2000) |
*
Delivery Date:
|
| *
Dealer Name: |
|
| *
First Name: |
*
Last Name:
|
| *
Street Address: |
|
| *
City: |
* State:
* Zip:
|
| *
Phone: |
Fax:
|
| *
E-mail Address: |
|
| |
• Optional
Fields- Please answer the questions
below for us to better serve you and to improve customer care
|
| What is the primary
reason you purchased Infratherapist (e.g. detoxification,
weight loss, arthritis, relaxation)? |
|
|
| How long did it take
for you to make up your mind to purchase Infratherapist
after your first inquiry? |
|
|
| What
was the greatest influence on your decision to purchase?
(e.g. friend's recommendation)? |
|
|
| Where are you planning
on setting up your Infratherapist? (e.g. bedroom,
personal gyms, bathroom, patio)? |
|
|
| Please tell us
about your hobbies and interests (e.g. jogging,
gardening, day spa, cooking)? |
|
|
| Your Primary
Residence: |
|
|
|
| Your Age Group: |
|
| Not including
yourself, what are the ages of the other people living in
your household? |
| Male (age in years):
Female (age in years):
|
| Family Income: |
|
| Your Education: |
|
| Your Profession: |
|
| What areas of
your health or beauty are you most concerned about?l |
|
|
| What are you currently doing to improve
your overall health or beauty (e.g. exercise,
herbal medicine, aromatherapy)? |
|
|
| What magazines or publications do you subscribe to? |
|
|
THANK YOU FOR TAKING YOUR
TIME TO FILL OUT THE ABOVE INFORMATION. PLEASE DOUBLE
CHECK ALL ENTRIES BEFORE SUBMITTING. THE INFORMATION
YOU'VE PROVIDED IS ESSENTIAL TO THE WARRANTY REGISTRATION
PROCEDURE. |
|
|
