Bowflex SELECTTECH - Page 36

Bowflex®SelectTech*MDumbbells Warranty RegistrationCard
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PLEASEPRINTCLEARLY- THANKYOU
[] Mr. [] Mrs. [] Ms. [] Miss
Serial # I
CustomerID from Invoice I
Name:
Address: I
CiW:
Phone number:
I-Mail address:
I-I EXT.I
State:
Apt. #: I
ZIP: I
Is this your primary address? [] Yes
Place of purchase:
Date of purchase:
M M
Purchaser date of birth:
M M
Gender: []Male []Female
[]No
D D Y Y
D D 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:
[] 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?
Bid you receive this item asa gift? [] Yes
Name of original purchaser: I
Original purchaser customer ID number:
[]No
Thanksfor filling out this questionnaire. Your answers are important to us. Please check here [] if you would prefer
notto obtain information on new and interesting opportunities from other exciting companies.
@ 2004, Nautilus Inc, All RightsReserved. 1400 N,E, 136th Ave,, Vancouver, WA 98684.Bowflex, and SelectTeeh loges are either registered trademarks or trademarks o1Nautilus Inc, 17241 BeyAA (03/0d) Nautilus Inc.