11
WARRANTY
Please complete and return this product warranty card or register your product online
at: backtobasicsproducts.com within 10 days of purchase.
THIS INFORMATION IS FOR INTERNAL USE ONLY
Mr.
Mrs.
Ms.
Model: Coffee
Solution
TM
CC500
1. Name ___________________________________________________________________________
2. Address _________________________________________________________________________
City ______________________________________ State ______ Zip Code ___________
3. E-Mail Address __________________________________________________________________
4. Age: 18-24
25-34
35-49
50+
5. Marital Status: Married
Single
6. Number of Children in the House : 12 yrs and under _________ 13-18 yrs _________
7. Income: Below $25,000 $25,001-$50,000 $50,001-$75,000 $75,001+
8. Where was this product purchased? _______________________________________________
9. How did you become aware of this product?
____ Gift
____ Recommendation from friend
____ TV advertisement
____ Saw product in store
____ Print ad
____ TV shopping program
____ Magazine article
____ Internet
____ Other _________________________
10. What were the two most important reasons infl uencing your purchase:
____ Gift
____ Recommended by sales person
____ Special offer
____ Recommended by friend
____ Product appearance
____ Prior experience with Back to Basics
____ Ease of operation
____ Back to Basics brand reputation
____ Quality/durability
____ Value for price
____ Product features
____ Product packaging
____ Other _________________________
11. Why did you purchase this Back to Basics product?
____ To replacement/upgrade current product
____ Not satisfi ed with current product(s) already owned
____ First product(s) ever owned
____ Received as a gift
12. Would you be interested in being contacted via e-mail for promotions, recipes, new
product information, etc.?
YES
NO
COMMENTS _______________________________________________________________________
___________________________________________________________________________________
Mr.
Mrs.
Ms.
Mr.
Mrs.
Ms.
Mr.
Mrs.
Ms.
7. Income: Below $25,000 $25,001-$50,000 $50,001-$75,000 $75,001+
7. Income: Below $25,000 $25,001-$50,000 $50,001-$75,000 $75,001+
7. Income: Below $25,000 $25,001-$50,000 $50,001-$75,000 $75,001+
7. Income: Below $25,000 $25,001-$50,000 $50,001-$75,000 $75,001+
product information, etc.?
YES
NO
product information, etc.?
YES
NO
4. Age: 18-24
25-34
35-49
50+
5. Marital Status: Married
Single
5. Marital Status: Married
Single
4. Age: 18-24
25-34
35-49
50+
4. Age: 18-24
25-34
35-49
50+
4. Age: 18-24
25-34
35-49
50+
