Century Furniture Product Registration

We at Century Furniture thank you for purchasing our furniture. Your retailer can assist you in many areas. We would, however, like to know more about you. Therefore, we ask you to complete the following questionnaire and register your purchase with us. Please note that your responses will be used for our information purposes only. No names will be sold to outside mailing companies.

Required fields are denoted with an asterik (*)

First Name: *

Last Name: *

Occupation:

Email: (?)

Address 1: *

Address 2:

City: * State: * Zip: *

You may record up to 6 item numbers from the stickers included on any product registration cards you received. These can also be found on the sales receipt, the back or bottom of your new furniture, or on the deck label of your new upholstery item.

Retailer:

Purchase Date:

City: State: Zip:

Century Furniture Product Registration

1. Age:

Under 25

25-34

35-44

45-54

55-64

65 & Over

2. Type of residence:

Single Family Home

Apartment

Condo/Townhome

Second Home

Other

3. How did you hear about Century Furniture?:

Newspaper

Magazine

Internet

Other

4. Is this your first purchase of Century Furniture?:

Yes

5. How likely would you be to recommend Century to others?:

Very Likely

Somewhat Likely

No Opinion

Somewhat Unlikely

Very Unlikely

6. What was the main reason for this purchase?:

Recent Move/New Home

Remodeling/Room Addition

Redecoration

Furniture Replacement

Desire For New Furniture

Second Home

Other

7. What else did you do that helped you decide on this purchase?:

Worked with a decorator/furnishing consultant

Shopped at retail store

Looked for ideas in magazines

Looked for ideas in catalogs

Looked for ideas on the Internet

Looked for items for sale on the Internet

Looked for sales in the newspaper

Visited centuryfurniture.com

8. What were the most important features that prompted you to purchase this Century Furniture product?:

9. What improvements could be made to this product?: