
1. Mr. 2. Mrs. 3. Ms. 4. Miss
First Name Initial Last Name
Street Apt. No.
City State/Province ZIP Code/Postal Code
E-mail
IMPORTANT!
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QXV01-01
2. Your date of birth:
Month Year
3. Marital status: 1. Married 2. Single
4. Date of purchase:
Month Day Year
5. Purchased from (name of store, catalog, etc.):
6. What two (2) factors most influenced your decision to purchase
from this retailer?
1. Variety of Products 5. Shop There Frequently
2. Lower Prices 6. Close to Home
3. Good Customer Service 7. Had Desired Product
4. Quality of Products 8. Easy to Shop
7. Who had the biggest influence in purchasing this product?
Male Female
1. Yourself
2. Under 12 Years Old
3. Age 13-17
4. Age 18-25
5. Age 26-49
6. Age 50+
8. What was the main reason for this purchase?
1. Recent Move 6. Remodeling/Redecorating
2. Replacing Furniture 7. Setting-up a Home Office
3. Divorce 8. Purchased TV/Computer
4. Marriage 9. Other
5. Furnishing a Spare Room
9. Where did you first see this product?
1. In the Store 4. Manufacturer Website
2. Catalog 5. Flyer
3. Retailer Website 6. Other
10. What three (3) factors most influenced your product purchase?
01. Price 09. Gift
02. Style 10. Quality
03. Color/Finish 11. Salesperson
04. Functionality 12. Warranty
05. Special Features 13. Size
06. Storage Space 14. Was on Sale
07. Store Display 15. Amount of Work Surface
08. Brand Name
11. Where will this furniture primarily be used?
01. Living Room 07. Dining Room
02. Family Room/Den 08. Master Bedroom
03. Personal Home Office 09. Child’s Bedroom
04. Home Business Office 10. Other Bedroom
05. Commercial Office 11. Student Dorm/Apartment
06. Kitchen 12. Other
12. Which of the following will you use with your new furniture?
1. Plasma TV 6. Personal Computer
2. Projection TV 7. Notebook/Laptop
3. LCD TV 8. Computer LCD Monitor
4. Tube (Regular) TV 9. Computer CRT Monitor
5. TV/Computer Monitor 10. None of the Above
13. If you plan to use a Computer Monitor or TV with your new
furniture what size is it (in inches)?
1. 15-17 5. 33-39
2. 18-21 6. 40-50
3. 25-27 7. 50+
4. 30-32
14. Who assembled your furniture?
1. Myself 5. Purchased Service
2. Spouse Separate from Product
3. Roommate 6. Other
4. Included in Price Paid
15. Please rate your satisfaction Very Not
with: Satisfied Satisfied Satisfied
Ease of Assembly........................... 1. 2. 3.
Delivery/Installation....................... 1. 2. 3.
Experience with the Store ............ 1. 2. 3.
Value for Price Paid ...................... 1. 2. 3.
Overall Satisfaction....................... 1. 2. 3.
16. Which of the following furniture items do you plan to buy
in the next year?
1. Home Office 6. Storage Cabinet
2. Entertainment Center 7. Closet Organizer
3. Audio Stand 8. Kitchen Cart
4. TV/VCR Stand 9. Utility/Storage Cart
5. Bedroom Furniture 10. Media Storage
17. Would you consider purchasing another one of our products?
1. Yes 2. No
18. Not including yourself, what is the GENDER and AGE (in years)
of children and other adults living in your household?
1. No One Else in Household 2. Child Under 1 Year
Male Female Age Male Female Age
1. 2. 1. 2.
1. 2. 1. 2.
19. Occupation: (check all that apply)
You Spouse
Professional/Technical........................................ 1.
Upper Management/Executive ........................ 2.
Middle Management ......................................... 3.
Sales/Marketing................................................... 4.
Clerical/Service Worker...................................... 5.
Tradesman/Machine Operator/Laborer.......... 6.
20. Are you or your spouse: You Spouse
A Homemaker? ................................................... 1.
Retired? ................................................................ 2.
A Student? ........................................................... 3.
Self Employed/Business Owner?........................ 4.
Working from a Home Office? .......................... 5.
In the Military?...................................................... 6.
A Veteran?........................................................... 7.
21. Which group best describes your annual family income?
01. Under $15,000 08. $75,000-$99,999
02. $15,000-$19,999 09. $100,000-$124,999
03. $20,000-$29,999 10. $125,000-$149,999
04. $30,000-$39,999 11. $150,000-$174,999
05. $40,000-$49,999 12. $175,000-$199,999
06. $50,000-$59,999 13. $200,000-$249,999
07. $60,000-$74,999 14. $250,000 & over
22. Level of education: (check highest level completed)
1. Completed High School
2. Completed College
3. Completed Graduate School
23. Which credit cards do you use regularly?
1. American Express, Diners Club
2. MasterCard, Visa, Discover
3. Department Store, Oil Company, etc.
4. Do Not Use Credit Cards
24. For your primary residence, do you:
1. Own? 2. Rent?
25. Please tell us how many magazines your household:
A. Subscribes to B. Purchases at Stores/Newsstands
1. 1-3 per month 1. 1-3 per month
2. 4+ per month 2. 4+ per month
26. Which of the following do you plan to do within
the next 6 or 12 months? 1-6 7-12
Months Months
Buy/Lease a New Vehicle.................................. 1.
Buy/Lease a Used Vehicle ................................. 2.
27. Please check all that apply to your household?
01. Shop by Catalog/Mail 08. Own a Wireless/
02. Shop Via the Internet Cellular Phone
03. Member of Frequent 09. Subscribe to an Online/
Flyer Program Internet Service
04. Donate to Charitable 10. Speak Spanish
Causes 11. Own an Apple/
05. Own a Compact Macintosh Computer
Disc Player 12. Own a CD-ROM Drive
06. Have a Dog 13. Home Workshop/
07. Have a Cat Do-It-Yourself
PLEASE CONTINUE ON BACK
yrs. yrs.
yrs.yrs.
We want to hear from you . . .
Return this completed product registration card within
the next 10 days to receive these important benefits or
save postage and time by registering online at:
www.prodregister.com/bf
1. Customer Service
Return your product registration within ten days.
The sooner we have your information, the better
we are able to help you.
2. Protect Your Product
We will keep the model number and Bush
Furniture product on file to help you refer to this
information in the unlikely event you require
replacement parts or need to file an insurance
claim.
3. Register Your Purchase
Returning this registration card is the only way
to guarantee that you will be notified by Bush
Furniture of any issues that arise concerning
this product. If you have any questions, comments
or suggestions about your purchase or any Bush
Furniture products, please call us toll-free at:
1-800-950-4782 or write us at:
BUSH FURNITURE, CONSUMER SERVICE
1111 ALLEN STREET, JAMESTOWN, NY 14702
YOUR PARTICIPATION IS GREATLY APPRECIATED
Thanks for taking the time to fill out this questionnaire.
Your answers will be used for market research and
internal reports and will help us better serve you
in the future.
If you have any comments or suggestions about our
product, please write to:
Consumer Service Department
P.O. Box 460
One Mason Dr.
Jamestown, NY 14702
1-800-950-4782
ConsumerService@BushIndustries.com
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