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Warranty Registration for DashMat Dashboard Covers

1
First Name:
Initial:
Last Name:
Address: (Number and Street)
Apt #:
City:
State/Province: (Required if US or Canada)
Country:
Zip: (Required if US or Canada)
 
2 Date of purchase:
/ /

(Example: January / 20 / 2002)
 
3 Was this product:
Received as a gift?
Purchased for your own use?
 
4 Which item did you purchase?
DashMat
VelourMat
UltiMat
Custom floor mat
 
5
A. Is this product custom embroidered?
Yes
No
B. If yes, what was embroidered?
Logo (University, etc.)
A name, initials, etc.
 
6 Purchase price:
$
.00
 
7
A. Where did you purchase this product (store name)?
B. Did you shop around at other stores before making this purchase?
Yes
No
 
8 What type of vehicle will this product be used on?
Make: (e.g., Ford)
Model: (e.g., Mustang)
Year: (e.g., 2000)
 
9 How many vehicles are in your household?
 
10 Does this product meet your expectations?
 
11 Your gender:
Male
Female
 
12 Your marital status:
Married
Single
 
13 Date of your birth:
/ /

(Example: January / 20 / 1980)
 
4 Including yourself, how many people live in your household?
Children (18 and younger)
Adults
 
15 Date of birth of children in your household 18 years of age and younger:
 
Male

Female
Birth
Month
Birth
Year
Child # 1 (eg., 2001)
Child # 2 (eg., 2001)
 
16 For your primary residence, do you:
Own
Rent
 
17 Education:
(Please select which category applies to you)
 
18 Which best describes your family income?
 
19 I/we buy these things through the mail,
over the Internet, or from television:

 
Mail
Internet
TV
Books/Magazines
Checks (not from a bank)
Children's products
Clothing
Computer products
Cosmetics/jewelry
Crafts/hobbies
Gardening supplies
Gifts
Housewares/furnishings
Insurance/financial products
Music/video/DVD
Sports equipment
Travel
Other
 
20 I/we have these credit cards:
American Express/Diners Club Visa/Master Card
Discover Other
Retail/Gas None
 
21 Someone in my home enjoys:
Astrology Gourmet food/cooking
Auto racing Grandchildren
Automotive work Home decorating
Books Hunting/shooting
Camping/hiking Investing
Casino gambling Lottery/sweepstakes
Cigars Pets-cats
Collecting Pets-dogs
Computers/Internet Pets-other
Cooking/recipes Photography
Crafts/needlework Play sports
Cultural art/events Self improvement
Cycling Skiing/snowboarding
Dieting/weight control Travel-Foreign
Do-it-yourself Travel-U.S.
Donating to charity Vacation cruises
Fishing Vitamins/natural foods
Fitness/exercise Wines
Gardening Woodworking
Golf Worship/Bible
 

Thank you! We appreciate your responses to this questionnaire. The information you choose to share with us will be used by us and our marketing partners to offer you product information and other communications that may interest you. If you prefer not to be contacted about these special offers, please check the box at the left.

 
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