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Haier Beer Dispensers Registration

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  1. Name & Address:  
     
    * Title Mr.    Mrs.    Ms.    Miss
    * First Name Initial * Last Name
           
    * Street Apt. No. * City
    * State/Province * Zip/Postal Code
    * E-mail Address
    2.  
  2. Your date of birth:
    3.  
  3. Marital Status: Married Single
    4.  
  4. Telephone Number: ( ) -
    5.  
  5. * Date of purchase: 
    6.  
  6. Model number:
    7.  
  7. Serial number:

    BRAND banner
    8.  
  8. Name of store where purchased:
    9.  
  9. Price paid (excluding sales tax): $ .00
    10.  
  10. Did you purchase an extended warranty with this product?  
    Yes No
    11.  
  11. What was the primary reason for this purchase?
     
    Entertianing
    Personal beer consumption
    Complement to household bar
    Gift
    Other
    12.  
  12. Select the (3) most important factors influencing your purchase of this product.
     
    Received as a Gift
    Friend's/Relative's Recommendation
    Salesperson's Recommendation
    Haier® Reputation
    Prior experience with Haier®
    Style/Appearance
    Product Packaging    		 Product Features
    Value for Price
    Warranty
    In-Store Display
    Quality/Durability
    Advertising
    Other
    13.  
  13. How did you first learn of this Haier® product?
     
    Received as a Gift
    Newspaper Advertisement
    In-Store Display
    Magazine Advertisement    		 TV Advertisement
    Salesperson's Recommendation
    Friend's/Relative's Recommendation
    Other
    14.  
  14. Who was the primary decision maker for this purchase?
     
    Male Head of Household
    Female Head of Household
    Joint Decision
    Landlord/Management Agency
    15.  
  15. What other brands did you consider before you purchased Haier?
     
    Haier was the only brand considered
    Avanti
    Beverage-Air
    Danby
    Marvel     		Northland
    Sanyo
    Summit
    Other
    16.  
  16. Do you own any other Haier products?
     
    Yes No
    17.  
  17. Excluding this purchase, which of the following appliances are you planning to purchase within the next year? (check all that apply)
     
    Washer
    Dryer
    Refrigerator
    Freezer
    Range
    Oven
    Microwave
    Dishwasher    		 Air Conditioner
    Wine Cellar
    Beer Dispenser
    Beverage Center
    Compact or Portable Appliance
    Other
    None of the above
    18.  
  18. What publication do you or someone in your household read?
     
    Magazine Name Buy from News Stand Subscribe to
    19.  
  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.  
  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.  
  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.  
  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.  
  23. Level of education: (select highest level completed)
     
    Completed High School
    Completed College
    Completed Graduate School
    24.  
  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.  
  25. For your primary residence, do you:
     
    Own? Rent?
    26.  
  26. How recently did you move into your current residence?
     
    Within 30 days
    Within 1-3 months
    Within 4-6 months     		7 to 12 months ago
    Have not moved in the last 12 months
    27.  
  27. Which of the following do you plan to do within the next 1-6 or 7-12 months?
    (select all that apply)
     
      1-6 Months 7-12 Months
    Buy/Lease a New Vehicle
    Buy/Lease a Used Vehicle
    28.  
  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
    29.  
  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.
     
    01. Bicycling
    02. Golf
    03. Physical Fitness/Exercise
    04. Running/Jogging
    05. Snow Skiing
    06. Tennis
    07. Camping/Hiking
    08. Fishing
    09. Hunting/Shooting
    10. Powerboating
    11. Sailing
    12. Grandchildren
    13. Needlework/Knitting
    14. Sewing
    15. Flower Gardening
    16. Vegetable Gardening
    17. Crafts
    18. Buy Prerecorded Videos
    19. Automotive Work
    20. Electronics
    21. Home Workshop/Do-It-Yourself
    22. Recreation Vehicles (RVs)
    23. Listen to Records/Tapes/CDs
    24. Avid Book Reading
    25. Bible/Devotional Reading
    26. Health/Natural Foods     		27. Photography
    28. Cultural/Arts Events
    29. Fashion Clothing
    30. Art/Antique Collecting
    31. Foreign Travel
    32. Cruise Ship Vacations
    33. Travel in USA
    34. Gourmet Cooking/Fine Foods
    35. Wines
    36. Stamp/Coin Collecting
    37. Collectibles
    38. Our Nation’s Heritage
    39. Real Estate Investments
    40. Stocks/Bond Investments
    41. Contests/Sweepstakes
    42. Casino Gambling
    43. Science Fiction
    44. Wildlife/Environmental Issues
    45. Dieting/Weight Control
    46. Science/New Technology
    47. Self-Improvement
    48. Walking for Health
    49. Watching Sports on TV
    50. Home Video Recording
    51. Moneymaking Opportunities
    30.  
  30. Using the numbers in the above list, please indicate your 3 most important activities:
     
           
    31.  
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