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  First Name: *   Last Name: *
   
  Street Address 1: *   Street Address 2:
   
  Postal Code: *   City: *
   
  State: *   Country: *
   
  Phone Number:   E-Mail:
   
  Serial Number: *
    - -
  *What is my serial #?
  Model Number:
 
  Purchased Price:
 
  Purchased Place:
 
  Date of Purchase:
 
     * Denotes Required Field
1. Please add me to the Hearthware Mailing List.
 Yes  No
2.      A. Who was the Primary Purchaser?
 Male  Female
 Single  Married
B. Age?
 Age 20-29  Age 40-49  Age 60-69
 Age 30-39  Age 50-59  Age 69 Over
C. How many members belong to your household ?
 1 - 2  5 - 6
 3 - 4  6+
3. How did you hear about this item?
 a) Retail Store Display  d) Friends / Family  g) Other
 b) Infomercial / TV  e) Catalogue / Magazine
 c) Newspaper  f) Internet
4. What features convinced you to purchase this item?
 a) Portability  d) Price  g) Healthier Cooking
 b) Speed  e) Cooking Frozen Foods  h) Other
 c) Energy-Saving  f) Ease of Operation
5. What are your favorite foods with the NuWave?
 a) Poultry  d) Seafood  g) Breads
 b) Beef  e) Vegetables  h) Other
 c) Pork  f) Breakfast
6. What do you like best about the NuWave Oven?
 a) Taste  d) Healthy Cooking  g) Doesn't heat up the kitchen
 b) Speed  e) Easy use & cleaning  h) Other
 c) Energy Saving  f) Compact Size
7. What foods are most important in your life?
 a) Beef  d) Vegetables  g) Other
 b) Pork  e) Seafood
 c) Poultry  f) Breads / Pasta
8. Where do you shop most often for electrical household goods? (Choose up to 3)
 a) Department Stores  d) Discount Dept. Stores  g) Infomercial / TV spots
 b) Internet  e) Specialty Stores  h) Other
 c) Price Clubs  f) Catalog / Mail Order
9. Do you have Cable TV?
 Yes  No
10. Would you recommend the NuWave Oven to your family or friends?
 Yes  No
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