| *First Name: |
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| *Last Name: |
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| *Email Address: |
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| Company: |
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| *Street Address: |
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| Street Address 2: |
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| * City: |
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| *Country: |
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| State: |
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| Province: |
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| Zip Code: |
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| Phone: |
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| Fax: |
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E-mail me with new Carrier product or service information.
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| Contact me by mail with product or service information. |
| Contact me by phone with product or service information |
| Have a local dealer contact me |
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| IMPORTANT! For proper registration, please fill in the serial & model number of this unit. |
| Which type of product are you registering for? |
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If "Other", please specify:
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| *Model Number: |
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| *Serial Number: |
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| *Date of Purchase: |
/
/
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| Name of Store where purchased: |
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| Price Paid: |
$
.00 |
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| Where Purchased: |
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If "Other", please specify:
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| Was this Purchase: |
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If this is a replacement or additional unit, what brand is this product you are replacing/adding to?
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| Was this purchase for home or business? |
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| What room(s) are you using this product for? |
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If "Other", please specify:
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| Please indicate how important each of the following factors were in your decision to purchase this product. Use a five point scale, 1 being the least important and 5 the most important: (please check one box in each row) |
| Price |
1
2
3
4
5
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| Overall value |
1
2
3
4
5
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| Quality |
1
2
3
4
5
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| Brand name |
1
2
3
4
5
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| Store or dealer recommendation |
1
2
3
4
5
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| Energy consumption |
1
2
3
4
5
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| Low sound level |
1
2
3
4
5
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| Style/Appearance |
1
2
3
4
5
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| Warranty |
1
2
3
4
5
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| Advertising |
1
2
3
4
5
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| Filter Efficiency |
1
2
3
4
5
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| Which of the following best represents your ethnic background? |
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| What type of home do you live in? |
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If "Other", please specify:
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| For your primary residence, do you:: |
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| Do you have access to the internet either at home or work? |
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| Over the past 12 months, approximately how many purchases have you made on the Internet? |
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| If you were purchasing another Carrier room air conditioner or portable air cleaner, how likely would you be to purchase on the Internet? |
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