Customer Information
|
|---|
|
First Name *
|
|
|---|
|
Last Name *
|
|
|---|
|
Company Name
|
|
|---|
|
E-mail *
|
|
|---|
|
Phone Number
|
|
|---|
|
Address *
|
|
|---|
|
Apt/Suite/Floor
|
|
|---|
|
City *
|
|
|---|
|
ZIP *
|
|
|---|
|
Country *
|
|
|---|
|
State *
|
|
|---|
About Product
|
|---|
|
Where did you purchase this Tanita Product?
|
|
|---|
|
Where did you hear about us?
|
|
|---|
|
Did you receive this Tanita product as a gift?
|
|
|---|
|
Will you primarily use this Tanita product to monitor your
|
|
|---|
|
How many people in your household will regularly use the body fat monitoring function?
|
|
|---|
|
How satisfied are you with each the following Tanita product attributes?
|
|
|---|
|
Product design
|
|
|
Overall satisfaction
|
|
|
Weight capacity
|
|
|
Features
|
|
|
Ease of use
|
|
|
Accuracy
|
|
|
How likely are you to recommend Tanita to your family and friends?
|
|
|---|
|
Internet survey
|
|---|
| Telephone survey
|
| Mail survey
|
| Testimonials
|
|
Tanita body fat / body composition monitors
|
|---|
| Tanita kitchen scales
|
| Tanita hand-held healthcare products
|
| Other, specify
|
|
Any additional comments or remarks?
|
|
|---|
|
About You
|
|---|
|
Your gender
|
|
|---|
|
Your age
|
|
|---|
|
Your highest level of education
|
|
|---|
|
Your annual household income
|
|
|---|
|
Approximate number of hours you exercise in a typical week
|
|
|---|
(Check all that apply.) |
Swimming
|
|---|
| Weight Lifting
|
| Others (baseball, basketball, etc.
|
| Marathons
|
| Running
|
| Walking
|
| Aerobics
|
| Triathlons
|
| Bicycling
|
| Yes, I'd like to receive periodic information on fitness and health measurement to help me lead a healthier life, as well special offers on healthy lifestyle products from Tanita.
|
Note: Communication will be sent to the e-mail address you provided. Your privacy will be fully respected. For your convenience, all future contacts will include a link to remove yourself from the program at any time. |
Thank you very much!
Note that the "Tanita Product Limited Warranty" requires proof of purchase for all warranty claims.
|
|
|---|
|