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Please fill this form out as completely as possible. Thank you!
Prefix
First Name(required)
Middle Initial
Last Name(required)
Street Address(required)
City
State
Zip Code(required) -
Phone Number --
Email Address(required)
Date of Purchase
(required)
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Model Number
Serial Number(required)
 
Dealer Information
 
Name of Dealer(required)
Address
Phone Number --
 
Optional Survey
 
How did you first become aware of this Juicer?
What factors most influenced your decision to purchase this Juicer?
For your primary residence, do you:
Occupation?
Which group describes your annual family income?
Which credit cards do you use regularly?
Do you have internet service?
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Have you ever purchased any products through online stores?
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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 veterain 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."
Please mark yes or no here if you do not wish to participate in this opportunity.
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