Registration Form



  PART A Registering your ownership: 
By Filling in these details you will help Tanita to contact you if necessary about your new purchase, and tell you about new products.
  Title  *
  First Name  *
  Last Name  *
  Address 
  State 
  Postcode 
  Age 
  Email 
  Date of Purchase 
  What model Body Fat Monitor did you purchase? 







  PART B About Your Purchase: 
Tanita are keen to listen to their customers about their changing needs. Your answers - and those of other customers - will be a great help to us.
  Did you purchase this product or receive it as a gift?  Purchased
Gift
  Reasons for Purchase (check all that apply) 
  Health Maintenance
Concerned about Body Fat
Monitor weight/fat loss
Other:
  How did you learn about this Tanita product? (check all that apply) 
  TV program
  Name of program 
  Newspaper
  Name of paper 
  Magazine Editorial
  Name of publication 
  Catalogue
Fitness instructor
Retail display
Doctor / Nutritionist
Sales Person
Internet
Friend / Relative
Health club
Other:
  Are you satisfied with the following product aspects? 
    Very Satisfied  Satisfied  Not Satisfied 
  Ease of use
  Features
  Accuracy
  Price
  Colour
  Overall design


  PART C About you: 
Tanita would also like to know more about you as a person - it helps when designing new products and planning advertising.
  Please indicate the number of people living in the home that will be using the Body Fat Monitor: 
  One Two
  Three Four
  Five Six
  More than six  
  Occupation 
  Where was the product purchased? 
  Don't know / recieved as gift 
  Department store 
  Name 
  Branch 
  Specialty store 
  Name 
  Branch 
  Mail Order 
  Name of catalogue 
  How many times a week do you exercise? 
  1 to 3 Times / Week
3 to 5 Times / Week
Daily
  Would you like to recieve additional information about Tanita products? 
  Yes
No
  Would you or a family member / friend be willing to take part in a published case study on health and body fat? 
  Yes
No
  Would you like to receive a complimentary copy of Alan Borushek's Fat and Calorie Counter? 
  Yes
No
  If you have any other comments or suggestions please feel free to include them here.