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Product Registration

Please enter your information below.
1.
First Name:
 Initial:
 Last Name:
Address: (Number and Street)
 Apt #:
City:
 State/Province:
Country:
 Zip:
Phone Number: () - -

Email Address:

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2. Item Number:

Serial Number:

UPC #:
upcbar.gif 2.53 K
(last 6 digits of UPC bar code located on product carton)

47171 *
3.
Date of Purchase:
/

(example: January/18/2001)

Place of Purchase:
(example: Walgreens, SteamFast Website, Television)

Purchase Price:
$.00
 
4. When you first noticed the product, what first caught your attention ?






5. Which three (3) of the following influenced your purchase decision:










 
6. Is this your first steam product purchase?
 

7. What room will this product be used in?
8. Would you recommend SteamFast products to others?
9. I also own the following SteamFast Products:
(check each product you own)
       





10. Education:

11. Which best describes your family income?

 
12. Gender:


Your marital status:

13. For your primary residence, do you:


 
14. Year of your birth:

 
(example: 1969)

15. Including yourself, what is the total number of people living in your household?

(Examples: 01,02,03...)

 
Other Comments
Thanks for filling out this questionnaire. Your answers are important to us.