Warranty Registration - Clark Enterprises 2000

First Name*

Last Name*

Street*

Apt. / Suite Number

City*

State*

Zip*

Email Address*

I received this product as a gift.

Yes
No

If yes, who purchased this for you?

What is the name of the machine you are registering?*

Serial Number*

Date of Purchase

Your responses to the following optional questions below will help us develop new products and services.

Date of Birth

What were the most important factors that influenced your purchase decision? (Check up to 3.)

Occupation (Check all that apply.)

Yourself:

Professional/Technical
Upper Management/Executive
Middle Management
Sales/Marketing
Clerical/Service Worker
Machine Operator/Laborer

Spouse:

Professional/Technical
Upper Management/Executive
Middle Management
Sales/Marketing
Clerical/Service Worker
Machine Operator/Laborer

Are you or your spouse:

Yourself:

A Homemaker?
Retired?
A Student?
Self Employed?
Work From Home?
In the Military?
A Veteran?

Spouse:

A Homemaker?
Retired?
A Student?
Self Employed?
Work From Home?
In the Military?
A Veteran?

Which group describes your annual family income?

For your primary residence, do you:

To help us understand our customers’ lifestyles, please indicate the interests and activities in which you or your spouse enjoy participating on a regular basis.

Phone

This field is for validation purposes and should be left unchanged.