PRODUCT REGISTRATION
Thank you for purchasing one of our fine Aqua Glass bathing fixtures. Please take a moment to complete the following registration process so that we may have a record of your purchase. The information you provide will help us to improve existing products, develop new products and put us more in touch with our customers. The information you provide will be used solely by Aqua Glass. Your information will NOT be provided to anyone outside our organization. We appreciate your help and thank you for your cooperation.
  1. Name & Address:  
     
    Title Mr.    Mrs.    Ms.    Miss
    * First Name Initial * Last Name
           
    * Street Apt. No. * City
    * State/Province * Zip/Postal Code
    * E-mail Address
    2.  
  2. Your date of birth:
    3.  
  3. Marital status: Married Single
    4.  
  4. * Serial number:
    5.  
  5. * Color of Aqua Glass unit purchased:
    6.  
  6. Where did you purchase this product?
    Did not Purchase/Pre-installed in home
    Plumbing Wholesaler
    Kitchen/Bath dealer
    Home Center     		Plumber
    Hardware Store
    Contractor/Builder
    Other
    7.  
  7. What was the reason for making this purchase?
    Did not purchase/Pre-installed in home
    New home construction
    Remodeling entire home
    Remodeling bathroom
    		 Building additional bathroom
    Replacing existing bathtub
    Other
    8.  
  8. Who installed your Aqua Glass bathing fixture?
    Self
    Friend
    Plumber     		Pre-installed in home
    Builder
    Other
    9.  
  9. What other brands have you owned?
    Repeat Aqua Glass buyer
    American Standard
    Crane
    Jacuzzi
    Kohler     		Lasco
    Maax
    Pearl
    Other:
    10.  
  10. * How would you rate this product for the following?
    1.
    Very Satisfied    		 2.
    Somewhat Satisfied    		 3.
    Neither Satisfied nor Dissatisfied    		 4.
    Somewhat Dissatisfied    		 5.
    Very Dissatisfied
    Finish of unit
    Installation (if self-installed)
    Installation Instructions
    Operating Instructions
    Operation (if applicable)
    11.  
  11. Would you recommend Aqua Glass to a friend?
    Definitely would Maybe Definitely would not No opinion
    12.  
  12. For the following product lines, please indicate (check all that apply)
    A.
    if you are aware of the product    		 B.
    if you purchased the product    		 C.
    if you would like additional information about the product
    Gelcoat Tubs/Showers
    Acrylic Tubs/Showers
    Steam
    Whirlpools
    Multipiece Bathing Fixtures
    Special Care ADA Products
    Fiberglass/Acrylic Cleaning Products
    13.  
  13. Not including yourself, what is the GENDER and AGE (in years) of children and other adults living in your household?
    No one else in household     Child under 1 year
    1.  Male   Female   Age (in yrs):
    2.  Male   Female   Age (in yrs):
    3.  Male   Female   Age (in yrs):
    4.  Male   Female   Age (in yrs):
     
  14. Please provide us with any feedback on our product such as how, if any, ways you would improve this product such as features, color, styling, etc. .. .(100 words or less)



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The data we collect is used in the aggregate to give us demographic information about the entire audience registering their products. We use this to understand that audience and to improve our offerings to you, our customers.

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All data is stored in a highly secure database with state of the art backup and firewall technologies. It is not accessible to any unauthorized parties.

 

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