Nautilus
®
SelectTech
®
Dumbbells Product Registration Card
IMPORTANT! MAIL WITHIN 30 DAYS OF PURCHASE
Thanks for filling out this questionnaire. Your answers are important to us. Please check here ■ if you would prefer
not to obtain information on new and interesting opportunities from other exciting companies.
PLEASE PRINT CLEARLY – THANK YOU
1. ■ 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:
■ 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:
© 2007. Nautilus Inc. All Rights Reserved. Nautilus, the Nautilus logo and SelectTech are registered trademarks of Nautilus, Inc.
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