|
|
|
Product Information
|
Please provide information about the product that you purchased that qualifies you for membership in Nexus®'s Power User's Club.
|
Product Serial No.*
|
Product Type*
|
Model*
|
|
|
Owner Information
|
|
First Name*
|
Last Name*
|
Company/Organization Name (If applicable)*
|
Street Address*
|
Unit #
|
City*
|
State* (If Outside of USA, Choose "Other")
|
Postal*
|
Country
|
E-mail
|
Phone
|
From time to time we conduct customer satisfaction/market research surveys and send important product anouncements via email to selected customers.
Would you like to receive these surveys and announcements?
|
|
|
Optional Information
|
|
| Please tell us about how this product was purchased |
This product was purchased:
|
Reseller Name
|
Reseller City & State
|
|
|
Please tell us about yourself
|
|
(By providing the following voluntary information, you will have an influence in determining Nexus®'s future
product matrix and marketing methods. Nexus® protects our customers privacy in accordance to our privacy policy.
Your information will be kept strictly confidential).
Did you personally make the decision to purchase this product?
|
Your Occupation or Industry
|
Household income
|
Age
|
Gender
|
Were you aware of Nexus® before you purchased/received this product?
|
How did initially you learn about Nexus®?
|
|
Did you intend to purchase Nexus® before you began shopping for this product?
|
|
|
How many Nexus® products have you owned prior to this product?
|
What was the primary reason to purchase this product?
|
|