•
Brother Product Registration
•
First Name
Last Name
Company
Name
Address
City State Zip
Co
de
Telephone Nu
mber
Model Number
Fax Number
Serial Number
Store Where Purchased
Purchase Date ( MM - DD - YYYY )
•
E-Mail
Address
1. How
did
you
first
becom
e
aware
of
t
his
B
rother
product?
(Please
Write
,n
ONE
Choice m the box 10 the left)
A.
Magazine Advertisement F
Friend/
Relative
B. Newspaper G. Dealer I Store Display
C.
TV Advertisement
H. Business Associate
D. Radio Advertisement Brochure
E. Brother
Website/
Internet J. Other
2.
What
other
Brother
products
do
you
own
or
have
you
purchased
in
the
past
?
(Please
Write
m top 3 choices m the
boxes
to the left)
A.
Embroidery Machine
F.
Printer
B.
Fax Machine G. Sewing Machine
c.
Label Maker
H.
Stamp Creator
D.
Laminator Typewriter
E.
Multifunction
3.
Whi
ch
of
the
following
factors
influenced
your
decision
to
buy
this
product
?
(Please
Writ
e m top 3 choices m the boxes
to
the left)
A. Advertisement G. Size I Weight
B.
Brother's Reputation
H. Store Flyer I Display
C.
Ease
of
Use Styling I Appearance
D.
Features J. Quality I Reliability
E.
Friend / Relative
K. Warranty
F.
Price I Value L. Other
4. Pl
ease
se
lect
the
primary
use
for
this
product?
(Please
Write
m
ONE
Choice
m the box
lo
the left)
A. Business
Use
( 1 - 5 Employees)
B. ( 6 - 19 Employees)
F.
(500 and Over)
C. ( 20 - 49
Emp
loyees)
G.
Personal Use
D. ( 50 - 99 Employees)
E. ( 100 -
499
Employees)
H. Student Use
Other
5.
Whi
ch
of
the
folowing
best
matches
your
age
group?
(Please
Writ
e m
ONE
Choice m the box
to
the left)
A.
18-24
D.
46
- 55
B. 25 -
35
E. 56 - 64
6.
Whi
ch
best
describes
your
occup
ati
on
?
(Please
Write
in
ONE
Choice m the box
to
the left)
A. Business Owner
B.
Clerical I Service
C.
Homemaker
D.
Management
G. Sales I Marketing
H.
Student
Teacher I Professor
J.
Tradesman / Laborer
E. Professional /
Te
chnical K.
Other
F. Retired
7. Which Hobbi
es
do
you
enjoy?
(Please
Write
in top 3 choices m the boxes to the left)
A.
Arts I Antiques
F.
Gardening
K.
Sewing
B.
Cooking
G.
Internet I PC
L.
Sports
C.
Crafts
H.
Music
M.
Travel
D.
Decorating
I.
Photography
N.
Other
E.
Electronics
J.
Reading
8.
Wh
ich
of
the
following
magazines
I publications
do
you read regularly?
(Please
Write
in
top 3 choices in the boxes
to
the left)
A.
Clotilde's Sewing Savy
F.
Good Housekeeping
B.
Create & Decora
te
G. Quilter"s World
C.
Designs
in
Machine Embroidery
H. Vogue Patterns
D.
Family Circle Crafts
Woman's Day Decorating
E.
Fons
& Porter Love of Quilting
J. Other
Would you like to receive Brother information regarding?
Special
offers
,
rebates
and
discounts?
N
ew
soft
war
e,
drivers
and
service
related
updates?
Newsletters
a
nd
surveys?
W
ebsite
updates
and
enhancements?
Please make sure you FILL in
your
choices
completely
.
To
view our privacy policy, go to www.registermybrother.com
YES
YES
YES
YES
NO
NO
NO
NO
C. 36
-45
F. 65 and over
111111111111
0039
•
Register On-Line at: www_registermybrother.com
Or Fax this side to 1-877-518-5702
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