BI
G
SH
OT
PORTRAIT
LAND
CA
M
ERA
REGISTR
AT
ION
CA
RO
Date Camera Acquired
________
_
How
was camera acquired? (Check one)
1 C Store Purchase 4
-1
Received as
gift
2
['
Mail
Purchase 5
~
None
of
the above
30 Military Exchange
1 Intend to use
this
camera
for:
(Check one)
1 0 Pleasure Only 3 C Both Business and
2 0 Business Only Pleasure
Please describe the
principal
user
of
this
camera:
Age: (Check one)
0 0 Under
10
2
c-:
20-29
4 0
40-49
1
[1
10-19
3
[J
30-39
50 Over
50
Marital Status: (Check one)
1 C Single 2 C Married 3 0 Other
Last school completed by head
of
household:
(Check one)
1
['
Grade School
30 College
2
'=l
High School
40 Graduate School
Do
you now or have you previously owned
another Polaroid Land Camera?
l '
Ves
2 0 No
If
yeso
which model?
________
_
1
Mr
.
2 Mrs.
3 Miss _
___
_
--:-::::--_
-:-
-.----
___
_
(Pl
e
ne
pr
i
nt)
Address
____
________
_
City
_______
State
_____
_
Zip
Code Telephone_
__
_
Camera Seriai
Number
____
____
_
Thank you
for
completlng
thls
cardo
P688
12
70
"Pall/Dld" e
Pr
lnled ln
U.S
.
A.
Aff
ix
Postage
Stamp
Here
Polaroid
Corporation
P.O.
Box
18S
Boston,
Massachusetts
02118