Please take a minute and use this form to register your product and to give us a little more information about yourself.

REQUIRED INFORMATION*

Title:	Mr. Mrs. Ms.
First Name* and Middle Initial:
Last Name*:
Address*:
City, State, Zip:
E-mail*:
Daytime Phone*:
Evening Phone:
Date of Birth:	1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31   January February March April May June July August September October November December
Marital Status:	Married Single
Date of Purchase:	1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31   January February March April May June July August September October November December
Purchase Price: before taxes	$.00
UPC number*: (last 6 digits of UPC bar code on product carton)	899071-
Place of Purchase:
Which one of the following products did you purchase?	Select One Clarity Skin Care Light Full Spectrum Floor Lamp Inspiration Deluxe LED Table Lamp (Model L4040) Inspiration LED Table Lamp (Model L3030) other:
What is the most important deciding factor in purchasing NatureBright?	(Please number 1-10 in order of importance - 1 being important) NatureBright's Name Quality Design Concept Value Usefulness Safety & Durability Advertisement Store Display Friend's/Relative's Recommendation
What other brands do you think that carry similar products to NatureBright?
Where did you hear of NatureBright?
Describe yourself:	one adult/no children one adult with children two or more adults couple/no children couple with children
Occupation: (check all that apply)	You Spouse Professional/Technical Professional/Technical Upper Management/Executive Upper Management/Executive Middle Management Middle Management Sales/Marketing Sales/Marketing Clerical/Service Worker Clerical/Service Worker Tradesman/Machine Operator/Laborer Tradesman/Machine Operator/Laborer
Annual combined income:	Under $50,000 $50,000-$74,999 $75,000-$99,999 $100,000-$124,999 $125,000-$149,999 $150,000-$299,999 $300,000 +
Level of education: (select highest level completed)	High School College Graduate School
For your primary residence, do you:	Rent Own
How long have you lived at your current residence?	6 months 7 - 12 months 1 - 2 years 3 - 5 years 5 years +
Your shopping style:	(check your most frequent shopping style) Catalog/Mail Order On-line In-Store
If you shop online, which site do you use most:	Amazon Ebay Yahoo Shopping Shopping.com Nextag.com Pricegrabber.com Google Search Other:   please specify
"Do you have any suggestions for new products or improvements to the existing products for NatureBright?

Thank you for completing this form. This information will be treated with complete confidentiality and is for our company's internal use only. We respect your privacy. The Nature Bright Company will not sell, rent or exchange your information. For more information, please read our privacy policy .