Nautilus
®
SelectTech
®
Dumbbells 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
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if you would prefer
not to obtain information on new and interesting opportunities from other exciting companies.
PLEASE PRINT CLEARLY – THANK YOU
1.
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Mr. 2.
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Mrs. 3.
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Ms.
4.
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Miss
Customer ID from Invoice
Name:
Address:
Apt. #:
City:
State:
Zip:
Phone number:
–
E-Mail address:
Is this your primary address?
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Yes
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No
Place of purchase:
Date of purchase:
Purchaser date of birth:
Gender:
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Male
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Female
Marital status:
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Married
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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?
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Yes
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No
Which best describes your family income:
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Under $15,000
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$25,000 – $34,999
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$50,000 – $74,999
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$100,000 – $149,999
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$15,000 – $24,999
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$35,000 – $49,999
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$75,000 – $99,999
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Over $150,000
What other types of exercise equipment do you own?
Did you receive this item as a gift?
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Yes
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No
Name of original purchaser:
Original purchaser customer ID number:
©.2007..nautilus.inc..all.rights.reserved..nautilus,.the.nautilus.logo.and.selecttech.are.registered.trademarks.of.nautilus,.inc..
