1. Name & Address:  
    

   * Title Mr.    Mrs.    Ms.    Miss
   * First Name	Initial	* Last Name
   * Street	Apt. No.	* City
   * State/Province	* Zip/Postal Code
   Alabama (AL)Alaska (AK)Alberta (AB)American Samoa (AS)Arizona (AZ)Arkansas (AR)Armed Forces AAArmed Forces AEArmed Forces APBritish Columbia (BC)California (CA)Colorado (CO)Connecticut (CT)Delaware (DE)District of Columbia (DC) Micronesia-FSM (FM) Florida (FL)Georgia (GA)Guam (GU)Hawaii (HI)Idaho (ID)Illinois (IL)Indiana (IN)Iowa (IA)Kansas (KS)Kentucky (KY)Louisiana (LA)Maine (ME)Manitoba (MB)Marshall Islands (MH)Maryland (MD)Massachusetts (MA)Michigan (MI)Minnesota (MN)Mississippi (MS)Missouri (MO)Montana (MT)Nebraska (NE)Nevada (NV)New Brunswick (NB)New Hampshire (NH)New Jersey (NJ)New Mexico (NM)New York (NY)Newfoundland (NL)North Carolina (NC)North Dakota (ND)Northern Mariana Is. (MP)Northwest Territories (NT)Nova Scotia (NS)Nunavut (NU)Ohio (OH)Oklahoma (OK)Ontario (ON)Oregon (OR)Palau (PW)Pennsylvania (PA)Prince Edward Island (PE)Puerto Rico (PR)Quebec (QC)Rhode Island (RI)Saskatchewan (SK)South Carolina (SC)South Dakota (SD)Tennessee (TN)Texas (TX)Utah (UT)Vermont (VT)Virgin Islands (VI)Virginia (VA)Washington (WA)West Virginia (WV)Wisconsin (WI)Wyoming (WY)Yukon (YT)Non-U.S./Non-Canadian International
   * E-mail Address

 
2. Your date of birth: Month January February March April May June July August September October November December Year 1918 1919 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
   
 
3. Marital Status: Married Single
   
 
4. Date of purchase:  Month January February March April May June July August September October November December Day 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Year 2009 2008 2007 2006 2005
   
 
5. Model number:
   
 
6. Purchased from (name of store, catalog, etc.):
   
 
7. What two (2) factors most influenced your decision to purchase from this retailer?
    

   Variety of Products Lower Prices Good Customer Service Quality of Products

   Shop There Frequently Close to Home Had Desired Product Easy to Shop

 
8. Who had the biggest influence in purchasing this product?
    

   	Male	Female
   Yourself
   Under 12 Years Old
   Age 13-17
   Age 18-25
   Age 26-49
   Age 50+

 
9. What was the main reason for this purchase?
    

   Recent Move Replacing Furniture Divorce Marriage Furnishing a Spare Room

   Remodeling/Redecorating Setting-up Home Office Purchased TV/Computer Other

 
10. Where did you first see this product?
     

    In the Store Catalog Retailer Website

    Manufacturer Website Flyer Other

 
11. What three (3) factors most influenced your product purchase?
     

    Price Style Color/Finish Functionality Special Features Storage Space Store Display Brand Name

    Gift Quality Salesperson Warranty Size Was on Sale Amount of Work Surface

 
12. Where will this furniture primarily be used?
     

    Living Room Family Room/Den Personal Home Office Home Business Office Commercial Office Kitchen

    Dining Room Master Bedroom Child's Bedroom Other Bedroom Student Dorm/Apartment Other

 
13. Which of the following will you use with your new furniture?
     

    Plasma TV Projection TV LCD TV Tube (Regular) TV TV/Computer Monitor

    Personal Computer Notebook/Laptop Computer LCD Monitor Computer CRT Monitor None of the Above

 
14. If you plan to use a Computer Monitor or TV with your new furniture, what size is it (in inches)?
     

    15-17 18-21 25-27 30-32

    33-39 40-50 50+

 
15. Who assembled your furniture?
     

    Myself Spouse Roommate

    Included in Price Paid Purchased Service Separate from Product Other

 
16. Please rate your satisfaction with:
     

    	Very Satisfied	Satisfied	Not Satisfied
    Ease of Assembly
    Delivery/Installation
    Experience with the Store
    Value for Price Paid
    Overall Satisfaction

 
17. Which of the following furniture items do you plan to buy in the next year?
     

    Home Office Entertainment Center Audio Stand TV/VCR Stand Bedroom Furniture

    Storage Cabinet Closet Organizer Kitchen Cart Utility/Storage Cart Media Storage

 
18. Would you consider purchasing another one of our products?
     

    Yes

    No

 
19. Not including yourself, what is the GENDER and AGE (in years) of children
    and other adults living in your household?
     

    No one else in household					Child under 1 year
    1.	Male		Female		Age (in yrs):
    2.	Male		Female		Age (in yrs):
    3.	Male		Female		Age (in yrs):
    4.	Male		Female		Age (in yrs):

 
20. Occupation: (check all that apply)
     

    	You	Spouse
    Professional/Technical
    Upper Management/Executive
    Middle Management
    Sales/Marketing
    Clerical/Service Worker
    Tradesman/Machine Operator/Laborer

 
21. Are you or your spouse:  
     

    	You	Spouse
    A Homemaker?
    Retired?
    A Student?
    Self Employed/Business Owner?
    Working from a Home Office?
    In the Military?
    A Veteran?

 
22. Which group describes your annual family income?
     

    Under $15,000 $15,000-$19,999 $20,000-$29,999 $30,000-$39,999 $40,000-$49,999

    $50,000-$59,999 $60,000-$74,999 $75,000-$99,999 $100,000-$124,999 $125,000-$149,999

    $150,000-$174,999 $175,000-$199,999 $200,000-$249,999 $250,000 & over

 
23. Level of education: (select highest level completed)
     

    Completed High School

    Completed College

    Completed Graduate School

 
24. Which credit cards do you use regularly?
     

    American Express, Diners Club MasterCard, Visa, Discover

    Department Store, Oil Company, etc. Do not use credit cards

 
25. For your primary residence, do you:
     

    Own?

    Rent?

 
26. Please tell us how many magazines your household:
     

    	A. Subscribes to	B. Purchases at Stores/Newsstands
    1-3 per month
    4+ per month

 
27. Which of the following do you plan to do within the next 6 or 12 months?
     

    	1-6 Months	7-12 Months
    Buy/Lease a New Vehicle
    Buy/Lease a Used Vehicle

 
28. Please check all that apply to your household.
     

    Shop by Catalog/Mail Shop via the Internet Member of Frequent Flyer Program Donate to Charitable Causes Own a Compact Disc Player Have a Dog

    Have a Cat Own a Wireless/Cellular Phone Speak Spanish Own an Apple/Macintosh Computer Own a CD-ROM Drive Home Workshop/Do-It-Yourself

 
29. To help us understand our customers' lifestyles, please indicate the interests
    and activities in which you or your spouse enjoy participating on a regular basis.
     

    Home Life 01. Grandchildren 02. Needlework/Knitting 03. Sewing 04. Flower Gardening 05. Vegetable Gardening 06. Crafts 07. Automotive Work 08. Photography 09. Home Video Recording Good Life 10. Cultural/Arts Events 11. Fashion Clothing 12. Foreign Travel 13. Cruise Ship Vacations 14. Travel in USA 15. Gourmet Cooking/Fine Foods 16. Wines 17. Self-Improvement 18. Watching Sports on TV 19. NASCAR Investing & Money 20. Real Estate Investments 21. Stocks/Bond Investments 22. Contests/Sweepstakes 23. Casino Gambling 24. Moneymaking Opportunities

    Sports, Fitness & Health 25. Bicycling 26. Golf 27. Physical Fitness/Exercise 28. Running/Jogging 29. Snow Skiing 30. Tennis 31. Health/Natural Foods 32. Dieting/Weight Control 33. Walking for Health Great Outdoors 34. Camping/Hiking 35. Fishing 36. Hunting/Shooting 37. Powerboating 38. Sailing 39. Recreation Vehicles (RVs) 40. Wildlife/Environmental Issues Hobbies & Interests 41. Buy Prerecorded Videos/DVDs 42. Listen to Records/Tapes/CDs 43. Avid Book Reading 44. Bible/Devotional Reading 45. Art/Antiques Collecting 46. Stamp/Coin Collecting 47. Collectibles 48. Our Nation’s Heritage 49. Electronics 50. Science Fiction 51. Science/New Technology

 
30. Using the numbers in the above list, please indicate your 3 most important activities:
     

Your Privacy Rights This statement discloses the privacy practices of this Product Registration website. We believe you should know: 1. What information this site gathers about you 2. What this site does with the information it tracks 3. With whom this site shares the information it gathers We collect personal information about our users only during product registration. We do not use cookie technology to track your movements. We respect your right to privacy. As part of the entry process, we give you the opportunity to decline to receive any communications from other parties to whom we may provide such information. The data we collect is used in the aggregate to give us demographic information about the entire audience registering their products. We use this to understand that audience and to improve our offerings to you, our customers. The personal information you provide - name, address, etc. - allows us to inform you of additional special offers which may be forthcoming, and to send you coupons, or notify you of products and services of our affiliates that relate directly to your specific interests, hobbies or other information you have given. Security All data is stored in a highly secure database with state of the art backup and firewall technologies. It is not accessible to any unauthorized parties. This means that your information is kept safe, and is only disclosed to selected third parties to provide you with valuable information and special offers. I do not want to receive coupons, mailings, or other special offers

Failure to submit this registration will not diminish your warranty rights.

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