** Please note that all fields need to be completed in order to register your warranty**

Personal Information
Name:
Address:
 
City
State:
Zip:
Phone:
Occupation:
Email:
   
Retailer Information
Name Of Store You Purchased From:
Retailer City and State: ,
Date Of Purchase:
Style Purchased:  
Order Number:  
   
About You and Your au Furniture Purchase
1. This was purchased by: Male      Female      Joint Purchase
2. Age:
3. Marital Status Married      Single      Divorced/Widowed
4. Type Of Residence:
5. Do you own or rent your home? Own      Rent
6. Children Give the number of children living at home by age and category:
Under 13:     
13 and Over:     
7. Annual combined family income:
8. What was your biggest motivation for purchasing au Furniture?
9. How did you become acquainted with au Furniture?
10. Is this your first purchase from au Furniture? Yes      No
11. What were the most important features that prompted you to purchase this au Furniture product?
12. What improvements could be made to this product?
13. What was the main reason for this furniture purchase?
14. When was your last furniture purchase prior to this one?
15. How long have you lived in your current residence?
16. How likely are you to purchase additional products from au Furniture?
17. How likely are you to recommend au Furniture to others?
18. Would you be interested in receiving correspondence from au Furniture including product information? Yes      No
19. May we add your name to our Customer Response Panel?  Periodically we request input from members of this panel.  Sometimes you could receive compensation for your participation. Yes      No