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                           To register your product online, fill out the information below and click on the "Go" button to send the information to us. THANK YOU!

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Title:	Mr.    Ms.  Mrs.  Miss
Full Name:	*
Street Address:	*                City: *
State/Province:	------United States----- Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming ---------Canada--------- Alberta British Columbia Manitoba New Brunswick Northwest Territories Nova Scotia Ontario Quebec Saskatchewan          Zip/Postal:
Telephone No.:            Email : *
Model#:	*                                Date of Purchase : *
¡¡	(See instruction manual)                                                   (MM/DD/YY£©
We would appreciate it if you would complete the additional information requested below. Although optional, it will help us continue providing you with the best products possible. THANK YOU!
Occupation:
	Homemaker	Crafts Worker
	Teacher/Educator	Machine Operator/Laborer
	Professional	Service Worker
	Executive/Administrator	Retired
	Middle Management	Student
	Sales/Marketing	Other than above
	Clerical
Your age group:
¡¡	-------Please Select------- 18-24 25-39 40-49 50 and over
The range of your family income:
	-------Please Select------- Under $10,000 $10,000 - $19,000 $20,000 - $29,000 $30,000 - $39,000 $40,000 - $49,000 $50,000 - $59,000 $60,000 and over
Place of your purchase:
	Other
	Department Store	Home Center
	Discount Store	Warehouse Club
	Catalogue Showroom	Mail Order
	TV Shopping Channel	Received as Gift
	Hardware Store	Direct from Pelonis USA
Who primarily decided to buy this product?
	A Male, Married	A Female, Married
	A Male, Single	A Female, Single
This product is a/an:
	First time Pelonis buy
	Replacement of a currently owned Pelonis product
	Addition to a currently owned Pelonis product
	Replacement of another brand
Please select 3 of the most important features of your product:
	Style/Appearance/Color	Quiet Operation
	Size/Portability	Temperature Controls
	Durability	Light Weight
	High Heat Output	Package Design
	Energy Efficiency	Add-on Accessories
	Safety	Warranty
How did you first become aware of this product?
	In-Store Display	TV Commercial
	Newspaper Ad	Store Salesperson
	Magazine Ad	Other
	Friend/Relative
Where will this product be used?
	Living Room	Bathroom
	Family Room	RV
	Bedroom	Mobile Home
	Child's Room	Office
	Kitchen	Porch
	Basement	Boat
	Sun Room	Other
Please give your comments about the product you have purchased:
Thank You Very Much Indeed for your time to complete this form!