Product Registration
Title
First Name*
Middle Initial
Last Name*
Address*
Address (cont'd.)
City*
State*
State
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
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Indiana
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Kentucky
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Maryland
Massachusetts
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Northern Mariana Islands
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Tennessee
Texas
Utah
Vermont
Virgin Islands
Virginia
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Zip*
Email*
Email*
Phone Number
Date of Birth
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1923
Purchase Date
MM
MM
01
02
03
04
05
06
07
08
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12
DD
DD
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02
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04
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11
12
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15
16
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20
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22
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25
26
27
28
29
30
31
YY
YYYY
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
Previous Brand
Previous Owned Brand
Sealy
Simmons
Select Comfort
Stearns & Forster
Tempur-Pedic
King Koil
Spring Air
Other
Store Name
City of Retailer you Purchased From
State of Retailer you Purchased From
Retailer State
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Which brand did you purchase?*
Which brand did you purchase?
Beautyrest
BeautySleep
SmartMotion
SleepTracker
Select Model
Select Model
Select Size
Select Size
Crib
Twin
Full
Queen
King
Other
What type of base did you buy?
Which type of base did you buy?
Standard
Low-profile
Nuflex Foundation (adjustable)
ReNew PowerBase (adjustable)
Other
None
Price Paid
Three top reasons for selecting
Salesperson
Sales/Promotion
Quality
Previous Experience
Dealer Reputation
Value
Comfort
Brand Name
While shopping, where did you get your information?
(Check all that apply.)
Internet
Magazine
Television
Radio
Other
Newspaper
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