Registration Information

Title: Mr. Mrs. Miss
First Name:
Middle Initial:
Last Name:
Street Address:
City:
State:
Zip:
Phone:
E-mail:
Model Number:
Serial Number:
Date of Purchase: / /20

Dealer Information

Name of Dealer:
Address:
Phone:

Optional Survey

How did you first become aware of the CitriStar Juicer?
Received as gift Magazine advertisement Newspaper advertisement TV advertisement Radio advertisement In-store display/demonstration Consumer magazine article Friend's/Relative's recommendation Salesperson's recommendation Information throughthe mail Other
What factors most influenced your decision to purchase the CitriStar Juicer?
Tribest reputation Style/Appearance Value for the price Special product features Warranty Rebate or sale price Quality/Durability Consumer magazine article
For your primary residence, do you:
Own a house? Own a townhouse or condominium? Rent a house? Rent an apartment, townhouse or condominium?
Occupation?
Homemaker Professional/Technical Upper Management/Executive Middle Management Sales/Marketing Clerical or Service Worker Tradesman/Machine Operator/Laborer Retired Student Self-Employed Business Owner
Which group describes your annual family income?
Under $15,000 $15,000 - $19,999 $20,000 - $24,999 $25,000 - $29,999 $30,000 - $34,999 $35,000 - $39,999 $40,000 - $44,999 $45,000 - $49,999 $50,000 - $59,999 $60,000 - $74,999 $75,000 - $99,999 $100,000 - over
Which credit cards do you use regularly?
American Express Diners Club Master Card Visa Discover Department Store Oil Company, etc. Do not use credit cards.

Do you have internet service?
Yes No

Have you ever purchased any products through online stores?
Yes No

Do you use email in your business communication?
Yes No

Do you use email in your personal communication?
Yes No

Do you regularly purchase items through the mail?
Yes No

Is there a military veteran in household?
Yes No

Are you a member of frequent flyer programs?
Yes No

Do you support health charities?
Yes No

Do you subscribe to cable TV?
Yes No

Do you use a personal computer?
Yes No

Do you have a microwave oven?
Yes No

Do you have a CD player?
Yes No

Do you have a VCR?
Yes No

Do you have a pet?
Yes No

We value your privacy! We will NEVER share your information with 3rd parties unless it is necessary to conduct business with you (for example, with our courier to send your orders to you) or if it is required by law.

From time to time, we would like to send you important information, like product updates or special offers. Please mark "yes" below if you would like to receive important product information, product updates, or special offers from Tribest. If you do not wish to receive the important product updates and special offers from Tribest, please mark "no." Yes No