Please fill out the warranty information below as completely as possible. Required fields are
designated by *.
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*First Name:
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Initial:
*Last Name:
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*Address:
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Address 2:
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*City:
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*State:
*Zip Code:
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Phone:
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E-Mail:
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*Date Purchased:
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(MM/DD/YY)
*Price: $
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* Label Name:
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Name Of Store or Outlet where you purchased your bed
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What size bedding did you purchase?
Twin
Full
Queen
King
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What type of bed did you purchase?
Innerspring
Foam
Air
Adjustable
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This bed was: (check all that apply)
Received as a gift
The first bed you have purchased
An additional bedding purchase
A replacement for a water bed
A replacement for an innerspring mattress
A replacement for a sofa bed
A replacement for a futon
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What reasons prompted this purchase: (check all that apply)
Did not have a bed
Needed a larger bed
Needed a smaller bed
Old bed worn out
Back/Sleep problems
Moved to college
Got married
Crib for new baby
Child moved from crib to bed
Moved to a new home
Remodeled bedroom
Added a new room
Bought a second home
Needed a guest bed
Other
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Who will be the primary user(s) of this bed?
Child(ren) - age(s)
Adult
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Approximate number of stores shopped for your new bed
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Types of stores shopped: (check all that apply)
Department store
General merchandise Store
Warehouse club
Specialty sleep shop
Toll-free 800 number phone order
Internet
Furniture store
Catalog Showroom
Catalog
Other
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About how long did you spend shopping for this purchase?
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What factors most influenced you to purchase your new bed from the store named above? (check all that apply)
Convenient Payment Options
Immediate / timely delivery offered
Received a free gift with the purchase
Salesperson's recommendation
Friend's / relative's recommendation
Past experience with store
Newspaper / TV / Radio / Circular / Flyer
Convenient location
Store guarantee
Item on sale
Lowest price
Other
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What other brands did you seriously consider before making this purchase (check all that apply)
King Koil
Kingsdown
Comfortaire
Restonic
Stearns & Foster
Serta
Simmons
Tempur-Pedic
Sealy
Spring Air
Select Comfort
Other
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What features most influenced this purchase? (check all that apply)
Style / appearance
Steel slats in foundation
Coil count
Firmness
Orthopedic design
Pillow-top design
Coil system
Other
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Which group describes your annual family income?
Under $15,000
$15,000 - $24,999
$25,000 - $49,999
$50,000 - $74,999
$75,000 - $99,999
Over $100,000
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Education:
High school
Some college
Completed college
Graduate school
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For your primary residence, do you:
Own a house
Own a townhouse or condominium
Rent a house
Rent apartment, townhouse or condominium
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Thank you for filling out this questionnaire. Your answers are important to us. Please check here
if you would prefer not to obtain information on new and interesting opportunities.
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