Jamestown Product Registration

Please take a moment now to register your purchase. Your valuable input regarding this purchase helps us develop products that will meet your needs in the future.

Name & Address:

* Title Mr. Mrs. Ms. Miss
* First Name	Initial	* Last Name

* Street	Apt. No.	* City

* State/Province	* Zip/Postal Code

* E-mail Address

Your date of birth:

Marital Status: Married Single

Date of purchase:

Model number:

Purchased from (name of store, catalog, etc.):

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

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+

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

Where did you first see this product?

In the Store
Catalog
Retailer Website Manufacturer Website
Flyer
Other

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

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

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

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+

Who assembled your furniture?

Myself
Spouse
Roommate Included in Price Paid
Purchased Service Separate from Product
Other

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

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

Would you consider purchasing another one of our products?

Yes No

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):

Occupation: (check all that apply)

	You	Spouse

Professional/Technical

Upper Management/Executive

Middle Management

Sales/Marketing

Clerical/Service Worker

Tradesman/Machine Operator/Laborer

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?

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

Level of education: (select highest level completed)

Completed High School

Completed College

Completed Graduate School

Which credit cards do you use regularly?

American Express, Diners Club
MasterCard, Visa, Discover

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

For your primary residence, do you:

Own? Rent?

Please tell us how many magazines your household:

	A. Subscribes to	B. Purchases at Stores/Newsstands

1-3 per month

4+ per month

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

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

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

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.
If you have questions or concerns about this site, our privacy policies, data use, or wish to change your options, click here.