Please complete and return this product warranty card or register your product online
at: backtobasicsproducts.com within 10 days of purchase.
Mr.
Mr.
Mr.
Mr.
1. Name __________________________________________________________________
2. Address _________________________________________________________________
City ______________________________________ State ______ Zip Code _____
3. E-Mail Address ____________________________________________________________
4. Age:
4. Age:
4. Age:
4. Age:
4. Age:
18-24
18-24
18-24
18-24
18-24
5. Marital Status:
5. Marital Status:
5. Marital Status:
6. Number of Children in the House :
7. Income:
7. Income:
7. Income:
7. Income:
7. Income:
Below $25,000
Below $25,000
Below $25,000
Below $25,000
Below $25,000
8. Where was this product purchased? ___________________________________________
9. How did you become aware of this product?
10. What were the two most important reasons infl uencing your purchase:
11. Why did you purchase this Back to Basics product?
12. Would you be interested in being contacted via e-mail for promotions, recipes, new
product information, etc.?
product information, etc.?
product information, etc.?
COMMENTS _______________________________________________________________________
__________________________________________________________________
WARRANTY
THIS INFORMATION IS FOR INTERNAL USE ONLY
Mrs.
Mrs.
Mrs.
Mrs.
Ms.
Ms.
Ms.
Ms.
25-34
25-34
25-34
25-34
25-34
Married
Married
Married
$25,001-$50,000
$25,001-$50,000
$25,001-$50,000
$25,001-$50,000
$25,001-$50,000
____ Gift
____ TV advertisement
____ Print ad
____ Magazine article
____ Gift
____ Special offer
____ Product appearance
____ Ease of operation
____ Quality/durability
____ Product features
____ To replacement/upgrade current product
____ Not satisfi ed with current product(s) already owned
____ First product(s) ever owned
____ Received as a gift
35-49
35-49
35-49
35-49
35-49
Single
Single
Single
12 yrs and under _________ 13-18 yrs _________
$50,001-$75,000
$50,001-$75,000
$50,001-$75,000
$50,001-$75,000
$50,001-$75,000
____ Recommendation from friend
____ Saw product in store
____ TV shopping program
____ Internet
____ Other ________________________
____ Recommended by sales person
____ Recommended by friend
____ Prior experience with Back to Basics
____ Back to Basics brand reputation
____ Value for price
____ Product packaging
____ Other ________________________
YES
YES
YES
19
Model: Blender Solution
50+
50+
50+
50+
50+
$75,001+
$75,001+
$75,001+
$75,001+
$75,001+
NO
NO
NO
5000
™