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Mr.
Mrs.
Ms.
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
$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:
Bowflex
®
SelectTech
™
220
Warranty
Registration Card
IMPORTANT! MAIL WITHIN 30 DAYS OF PURCHASE
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