Product Registration

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: