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© 2005, Nautilus Inc. All Rights Reserved. 16400 SE Nautilus Drive, Vancouver, Washington, USA 98683. Bowflex, and Motivator are registered trademarks of Nautilus Inc.
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2 Home Gym Product Registration Card
IMPORTANT! MAIL WITHIN 30 DAYS OF PURCHASE
Thanks 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.
PLEASE PRINT CLEARLY – THANK YOU
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: (US dollar figures)
Under $15,000 $25,000 – $34,999 $50,000 – $74,999 $100,000 – $149,999
$15,000 – $24,999 $35,000 – $49,999 $75,000 – $99,999 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:
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D D Y Y
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