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GREEN STAR
®
ELITE
REGISTRATION FORM
put glue here to seal
PLEASE FILL OUT AND RETURN WITHIN THE NEXT IO DAYS Please write all information legibly!
1. Customer Information
c Mr. c Mrs. c Ms. c Miss
First Name Initial Last Name
Street Apt. No
City State Zip
Phone Email Address
2. Date of Purchase: Month Day Year
3. Product Information:
Green Star Elite Model #: Serial #:
4. Dealer Information
Dealer Name
Dealer Address
Phone
• How did you learn of Green Star? (Please check only one.)
c Received as a gift c Magazine advertisement c Newspaper advertisement
c TV advertisement c Radio advertisement c In-store display or demo
c Consumer magazine article c Friend’s recommendation c Salesperson
c Information through the mail c Other
• What is your primary residence?
c Own a House c Own a Townhouse or Condo c Rent a House
c Rent an Apartment, Townhouse or Condominium
• What is your Annual Household Income?
c Less than $15,000 c $15,000-$25,000 c $25,000-$50,000
c $50,000-$75,000 c $75,000-$100,000 c more than $100,000
• What factors most influenced your decision to purchase this juicer? (please check up to three)
c Green Star reputation c Style and appearance c Value for the price
c Special product features c Warranty c Rebate or sale price
c Quality and durability c Consumer Magazine Article c Reputation of the Dealer
c Friend Recommendation c Salesperson c Other
• What is your occupation?
c Homemaker c Professional/Technical c Upper Management or Executive
c Middle Management c Sales/Marketing c Clerical or Service Worker
c Self Employed/Business Owner c Student c Retired
c Tradesman/Machine Operator/Laborer
• Which credit cards do you use regularly?
c Visa c MasterCard c American Express
c Discover c Department Store c Diner’s Club
c Gasoline Company, etc. c Do not use credit cards
OPTIONAL SURVEY
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