First Name
REGISTER AND SHOP
online at www.icm.siem&ns.com/register
Last Name
1
Number & Street Addr@aa
. . .--. ---
City
State
lrr-l
Zip Code
I I I I I I I I I I I I I I I I II /
Home Phone
Work Phone
[ID-[717-m II-1-1-1-m
EMAIL
Address
..-. ._-.---
r
1)
3)
4)
5)
6)
Which model number did you purchase? 2) When did you purchase?
- -
Where did you purchase?
(please speedy)
l
Consumer Electronics
l
Warehouse Club
l
Catalog
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Office Supply Store
l
Web Site
l
Received as gifl
l
Discount Superstore
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Department Store
Where did you learn about Sjergm,” products?
(check all that apply)
a
l
Magazine-
* Friend / Relative-
?
l
Newspaper Flyer- . TV- * Email-
7
l
In Store- * Internet Search Engine- * Other (please
specify)
8
What are the two (2) most important factors that influenced your purchase decision?
(check two)
2
d
l
Siemens Reputation-
* Expandability / Multi-Handset- * Value / Price-
8
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Voice Quality / Security-
* 2.4GHz Technology-
* Handset Speakerphone-
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Style I Appearance- * Voice Dialing-
;
Number of additional handsets you purchased? ~ Do you plan to buy additional handsets? ~
8
(For Siemens’ privacy policy go to www.icm.siemens.com) 5.01
5