Life Style by A.H.Beard

Warranty

Red Star * Denote Mandatory Fields

Name & Address:
Title: Mr. Mrs. Ms.
*First Name:Initial:*Last Name:
*Street:Apt. No.:*City:
*State/Province:*Zip/Postal Code:
*E-mail Address:
Your date of birth: / / dd/mm/yyyy
Marital Status: Married Single
*Date of purchase: / / dd/mm/yyyy
*Name of store where purchased:
Price paid: $ Mattress  
$ Box Spring  
Please indicate mattress size:
*Model Name:
Is this product: The first product of this type you have ever owned?
A replacement for another product of the same brand?
A replacement for a similar product made by another company?
An addition to a similar product you are still using?
Which group describes your annual family income? $0-$29,999
$30,000-$60,000
$60,001-$90,000
$90,001-$149,999
$150,000 & over
Level of education:
(select highest level completed)		 Completed High School
Completed College
Completed Graduate School
What product features most influenced this purchase?
(check all that apply)		 Style/Appearance
Pillow top design
Firmness
Coil Count
Coil System
Technology
Box Spring
Other
What factors most influenced your
decision to purchase this product?
(check all that apply)		 Brand reputation
Previous experience with this brand
Price
Specific Product Features
Salesperson's Recommendation
Friend's/Relative's Recommendation
Warranty Coverage
Other
Comments About The Product Or Your Shopping Experience:

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