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. Telephone Number: ( ) -
   
 
3. 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
   
 
4. Marital Status: Married Single
   
 
5. UPC code of the product you purchased: 043917-
   
   
                            
 
6. 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
   
 
7. Price paid (excluding sales tax): $ .00
   
 
8. Name of store where purchased:
   
 
9. Was this product purchased by:
    

   Male

   Female

   Age:

 
10. Ethnic origin of purchaser:
     

    African American Caucasian Hispanic

    Asian Other

 
11. Did you:
     

    Purchase this product yourself? Receive this product as a gift?

 
12. What factors influenced the purchasing decision?
     

    Advertisement Brand name Certain hair style Features Only model available Packaging/Appearance

    Price Recommendation Replacement Size Don't know Other

 
13. How important were each of the following features in the decision to purchase this product?
     

    	Not At All	Somewhat Important	Very Important
    Number of Heat Settings
    Number of Heating Elements
    Type of Styler (curling iron/texturizer/straightener)
    Barrel Size
    Constant Heat/Heat Recovery
    Ceramic-Advantage Barrels
    Automatic Shut-Off
    Heat Up Time
    Cord Length
    Instructional CD
    Heat Shield with Cord-Wrap

 
14. What is your hair type? (check all that apply)
     

    Neck or shorter Shoulders to mid-back Mid-back or longer Curly Wavy Straight

    Coarse Average Fine Thin Medium Thick

 
15. What is this product primarily used for?
     

    Curling hair Straightening hair Texturizing hair

 
16. Please answer the following questions only if an instructional CD was included with your product:
    
    A. How often have you used the CD?  

    1 time 2-3 times

    4 or more times Have not used it

    
    

    B. Which hairstyles have you reviewed on the CD?  

    Lift Flip Straighten

    Ribbon Decorate Curl

    C. How easy was the CD to use?  

    Not At All Somewhat Very

    D. How helpful was the CD to you?  

    Not At All Somewhat Very

    E. Overall, how satisfied are you with the instructional CD?  

    Not At All Somewhat Very

 
17. Please answer the following questions only if a Heat Shield was included with your product:
    
    A. How often do you use the Heat Shield?  

    Always Often

    Seldom Never

    B. How often do you use the Cord-Wrap on the Heat Shield?  

    Always Often Seldom

    Never Not Applicable

    C. How do you use the Heat Shield with your styler?  

    Mounted on Wall On the Counter

    To Store the Styler        in Drawer/Closet/Cupboard For Travel

    D. Overall, how satisfied are you with the Heat Shield?  

    Not At All Somewhat Very

 
18. How satisfied are you with each of the following features of your styler?
     

    	Not At All	Somewhat Satisfied	Very Satisfied
    Temperature of the Heat
    Constant Heat/Heat Recovery
    Ceramic Advantage Barrels
    Automatic Shut-Off
    Heat Up Time
    Cord Length
    Instruction Book
    Curling Iron/Ease of Use
    Curling Iron/Performance
    Texturizer/Ease of Use
    Texturizer/Performance
    Straightener/Ease of Use
    Straightener/Performance

 
19. Overall, how satisfied are you with this product?
     

    Completely satisfied Somewhat satisfied

    Somewhat dissatisfied Completely dissatisfied

 
20. How likely are you to recommend this product to someone else?
     

    Very likely Somewhat likely Not likely

 
21. What other personal care products do you currently own or intend to purchase in the next six months?
     

    	Currently Own	Intend to Purchase
    Hair dryer
    Electric shaver
    Hair cutting kit
    Curling iron/Styling brush
    Massager
    Beard/Mustache trimmer
    Lighted makeup mirror
    Heating pad
    Bath spa

 
22. 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):

 
23. Occupation: (check all that apply)
     

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

 
24. 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?

 
25. 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

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

    Completed High School

    Completed College

    Completed Graduate School

 
27. Which credit cards do you use regularly?
     

    American Express, Diners Club MasterCard, Visa, Discover

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

 
28. For your primary residence, do you:
     

    Own?

    Rent?

 
29. 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

 
30. 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

 
31. 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

 
32. 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

 
33. 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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