Product Registration Form

Please provide the following information:

First Name	MI       Last Name
Organization
Street Address
City
State/Province	Zip/Postal Code
Country
Email

Date of Purchase:    (format xx-xx-xx) Excluding tax, what price did you pay for this product?   Model Name: Product Name   Serial Number

Where was this product purchased?   Internet Received as a gift Office superstore Wholesale club General merchandise store (Sears, Wards, etc.) Mass merchandise store (Target, Kmart, etc.) Electronics store Computer superstore Computer specialty store Distributor Installer Mail order Other

Name of store where purchased:

What factors most influenced this purchase? (check all that apply) Product packaging Only brand available Brand reputation Friend's/Relative's recommendation Salesperson's recommendation Previous brand experience Value/Price Warranty Toll-free technical support  Easy installation Received as a gift  Product features

How did you first learn about this product?   Received as a gift Newspaper advertisement Newspaper insert/Store flyer Magazine article/review Store display In-store demonstration Friend/Relative Salesperson/Dealer Catalog Product brochure Other

What type of organization purchased this product? Home - Personal Home - Business Nonprofit/Charity K-12 Education College/Vocational Institution Business - under 25 employees Business - 25 to 99 employees Business - 100 to 500 employees Business - more that 500 employees Government

Which of the following products do you or your organization currently own or plan to purchase in the future? (check all that apply)

Own  Plan to Buy Desktop PC/Mac Portable PC/Mac Fax Modem Answering machine Cellular Telephone Computer Telephone Cordless Headset Telephone Facsimile Machine PC/Mac Scanner Caller ID Product Multi-line Telephones Pager (Non-Network) Which of the following telephone services do you or your organization currentlyuse or plan to use in the future?  (check all that apply) Use  Plan to Use DSL Line Call Waiting Caller ID Call Waiting Caller ID Call Waiting Caller ID Call Forwarding 3-Way Call Conferencing Call Blocking Speed Dialing Last Call Return VIP Alert  (Distinctive  Ring for Key Callers) 2-Ring Distinctive  Ring number 3-Ring Distinctive  Ring number Phone Company  Voice Mail Fax Mail Box  (Stores Incoming Faxes) ISDN Subscribe to On-Line Services (CompuServe / America Online, etc.)

Please indicate the number of phone lines being used: 1 line 2 lines 3 lines 4 lines 5 or more lines

Occupation: (check all that apply) Professional/Technical Upper Management/Executive Middle Management Sales/Marketing Clerical/Service Worker Tradesman/Machine Operator/Laborer

Check, if you would you like to be contacted regarding new products in the future?