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Bowflex
®
Ultimate
™
Warranty Registration Card
IMPORTANT! MAIL WITHIN 30 DAYS OF PURCHASE
Thank you for filling out this questionnaire. Your answers are important to us. Please check here if you would prefer
not to obtain information on new and interesting opportunities from other exciting companies.
■ Mr. 2. ■ Mrs. 3. ■ Ms. 4. ■ Miss Customer ID from Invoice
Name:
Address: Apt. #:
City: State: Zip:
Phone number: -
E-Mail address:
Is this your primary address? ■ Yes ■ No
Place of purchase:
Date of purchase:
Purchaser date of birth:
Gender: ■ Male ■ Female
Marital status: ■ Married ■ Single
Including yourself, total number of people living in your household: (Examples: 01, 02, 03 …)
Would you like to receive additional information on healthy lifestyle products? ■ Yes ■ No
Which best describes your family income:
■ Under $15,000 ■ $50,000 – $74,999 ■ $15,000 – $24,999 ■ $75,000 – $99,999
■ $25,000 – $34,999 ■ $100,000 – $149,999 ■ $35,000 – $44,999 ■ Over $150,000
What other types of exercise equipment do you own?
Did you receive this item as a gift? ■ Yes ■ No
Name of original purchaser:
Original purchaser customer ID number:
PLEASE PRINT CLEARLY – THANK YOU
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