On-Line Warranty Registration

About You
First Name		Last Name
Street Address
City		State ??CAALAK ARAZCOCT DCDEFLGA HIIAIDIL INKSKYLA MAMDMEMI MNMOMSMT NCNDNENH NJNMNVNY OHOKORPA PRRISCSD TNTXUTVT VAWAWVWI WYAAAEAP	Postal Code/Zip
Telphone Number		Email Address
Marital Status ?????? Other Married Single Widow	Date of Birth MO Day YR	Do you own/rent your home? ?????? Own Rent Other
About The Store
Product(s) Purchased From
City		State ??CAALAK ARAZCOCT DCDEFLGA HIIAIDIL INKSKYLA MAMDMEMI MNMOMSMT NCNDNENH NJNMNVNY OHOKORPA PRRISCSD TNTXUTVT VAWAWVWI WYAAAEAP	Postal Code/Zip
Was the Store Clean? Yes No		Were you treated courteously? Yes No
Purchase Date MO Day YR		What additional services did you use? ??????????? None Delivery Store Setup Financing
Bed Product
Name
Serial Number		Model Number
Cover Product
Name
Serial Number		Model Number
Mattress Product
Name
Serial Number		Model Number
Temperature Control Product
Name
Serial Number		Model Number
Help Us Help You!
Is this your first Land and Sky Product? Yes No		What is your income grouping? ??????????????? Up to $25000 $25001 - $50000 $50001 - $100000 Over $100000
Did you test this product in the store? Yes No		What is your occupation? ??????????????????????? Clerical/White Collar Tradesman/Craftsman Homemaker Dentist/Physician Professional/Technical Retired Sales/Service Management/Administration Other
Who made the ultimate decision to purchase this product? ?????? Self Spouse Parent Other		Do you have any health problems? ?????????????? Back Problems Arthritis Trouble Sleeping Other
What was the most important reason for purchasing a Land and Sky Product? ??????????????????????? Repution of Manufacturer Comfort Warranty Salesperson Dealer's Reputation Price Literature Advertisement Physician Recommended Previous Land and Sky Owner Other		What type of store did you buy your Land and Sky product from? ?????????????? Furniture Store Sleep Store Waterbed Store Department Store Used Other
How did you become aware of this product? ??????????????? In-store Display Magazine Ad Gift Friend/Relative Physician Store Salesperson Other		If you selected "Other" on the left, please describe below.
Would you like us to keep your information confidential?			Yes No
Would you like receive product mailings or updates?			Yes No
Additional Comments: