Product Registration Form

Please take a moment now to register your purchase. Your valuable input regarding this purchase help us to create the products you'll want in future. We'll also register you with the "ANUPAM GINIE" scheme for a chance to win exciting prizes or cash rewards. Thank you for your time, and thanks for choosing Anupam.

Untitled Document

1. Name & Address

Title*
First Name* Last Name*
State* City*
Postal Code* Email*
Mobile* Phone*
Address*

2. Personal Detail

D.O.B. Marital Status

3. Product Detail

Serial No. (e.g. 101 etc. is not the serial number.) Please look under the product or on the packaging for the serial number.
Model No. (e.g. 101 etc is the model number.) Please look in the catalog or top of the product or on the packaging.
Type Price Paid

4. Product Purchase Detail

Installed In
Purchased By
Dealer Name
Address of Dealer/Showroom

5. How you become aware of Anupam products (check all that apply)

Word of mouth Magazine Ad/Article
Direct mailer Newspaper Ad/Article
Store display Television/Radio advertisement
Internet search Professionals recommendation
Anupam website Other

6. What influenced your decision to purchase Anupam products (check up to three)

Anupams reputation Salespersons recommendation
Only product offered Previous experience with Anupam products
Price Professionals recommendation
Finish/Polish Friends/Relatives recommendation
Design In-store display
Product brochure Other

7. Occupation

Service Professional/Technical
Business Higher Management/Executive
Sales/Marketing

8. Qualification (select highest level completed)

Qualification

9. Your primary residence

Residence