1. Name & Address:
2. Date of Birth:
3. Marital Status:
4. Date of Purchase:
5. ALI (Ack-Line-Item):
6. Style Number:
7. Cover Number (Example: CD 801222 or D 801222):
8. Please indicate where you purchased this product:
9. Was the purchase:
10. What was the main reason for this purchase? (check all that apply)
11. How did you first become aware of this La-Z-Boy product?
12. What product features most influenced this purchase? (check up to 3)
13. What factors most influenced the decision to purchase the La-Z-Boy brand?
(check up to 3)
14. Which group describes your annual family income?
15. For your primary residence, do you: