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Purchaser Profile & Product Registration
IMPORTANT!!
Please complete within 10 days!
 IMPORTANT!!


  1. First Name
         		Initial
         		Last Name
    Street
         		Apt. No.
    City
         		State/Prov.
         		Zip Code/Postal Code
    Country
    Email Address:
  2. Your date of birth: /
  3. Marital status:
  4. Date of purchase:
  5. BORLA® Part Number: [lookup]
  6. Retailer
  7. Invoice # / Order #
  8. Which BORLA® product type did you purchase?








  9. What price did you pay for this product (excluding freight, tax, installation charges)?
     $
  10. Where was this product purchased? (check only one)















  11. What type of vehicle will this product be used in?









  12. If this is a pickup or sport utility vehicle, is it:
    1. Drive Type:

    2. Bed Size:
    3. Cab Size:
    4. Doors:

  13. What is the primary use of the vehicle this product is installed on?






  14. How many miles did you have on this vehicle before installing this product?








  15. What factors most influenced this purchase?















  16. What benefits of this product most influenced your decision to purchase?







  17. What other brand(s) did you seriously consider before making this purchase? (check all that apply)














  18. Which of the following magazines do you read regularly (most issues)? (check all that apply)
















  19. Which of the following Internet forums do you view regularly?






  20. Not including yourself, what is the GENDER and AGE (in years) of children and other adults living in your household?
    Age:   yrs.
    Age:   yrs.
    Age:   yrs.
    Age:   yrs.
  21. Occupation: (check all that apply)
    You













    		Spouse













  22. Which group describes your annual family income?














  23. Level of Education: (check highest level completed)




  24. Which credit cards do you use regularly? (check all that apply)







  25. In which of the following region do you live?



  26. For your primary residence, do you:
  27. Please check all that apply to your household:







Thanks for taking the time to fill out this questionnaire. Your answers will be used for our market research studies and reports only. We do not share or sell your name, address or any other data with any outside company for any purpose.

Please note this is a product registration, but for all warranty issues, be sure to follow the instructions on the Million-Mile Warranty literature that accompanied your BORLA® product, or refer to the Million-Mile Warranty page on our site.