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First Name:*
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Gender:* Male Female 
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Model Purchased:*
Store Purchased from:*
Name:*
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Date Purchased:*
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Price Paid:* $ 
 
How many pets do you own?*
How many cats do you own?
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Who or what influenced your purchase? (check all that apply)
AppearanceFunctionQualityPrice
Diabetic PetPet HealthOver Weight PetRadio/TV/Video
Magazine AddBrand ReputationCraftsmanshipFriends Recommendation
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Which of the following most accurately describes your occupation?
ProfessionalManufacturingSalesEducation
SportsArtsMusicBuilding Trades
BusinessServiceRetiredMilitary
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What are your hobbies or interests? (check all that apply)
FishingCampingHuntingGolf
TennisComputersPhysical FitnessCycling
Snowboarding/SkiingSkateBoardingPerformaing ArtsPhotography
Do-It-YourselfWoodworkingCasino GamblingScuba Diving
Auto RacingPro FootballPro BasketballPro Baseball
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Your household income?*
Less than $40,000 $40,000 to $75,000 $76,000 to $100,000 Over $100,000
 
  Yes, please email me updates about new product introductions, news and promotions.
 
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