Customer Information

* First Name:
* Last Name:
* Email:
* Phone:
* Street Address:
* City:
* State:
* Zip:

Product Information

* Model:
* Date of Purchase:
* Price paid:
Warranty Terms
Full 10-Year Warranty
Full 5-Year Warranty
Full 3-Year Warranty
Full 2-Year Warranty
Full 1-Year Warranty
Full 90-Day Warranty

Dealer Information

Name of store where purchased:

Additional Information

Male Female
Age Range:
Incomming Range(household):
Reason for Purchase:
If "Other":

Have you owned an inversion table before?

If "yes" please tell us more about your previous inversion table.
Model #:
Year Purchased:
Reason for replacement:
If "Other":
How did you hear about Teeter?
Have you seen Teeter's infomercial
Yes No
Did you consider other brands of inversion tables?
Yes No
If "Yes" wich brand did you consider?
Why did you choose Teeter?
If "Other":

On a scale of1 to 5 (being very important), please rank how important the following items were in your purchase decision.

Product Quality
Customer Reviews
Brand Reputation
Product Education
Retailer Demonstration
Online Video
Free Shipping Offered
Social Media Content

Opinions / Comments

We value our customers thoughts and opinions, what could Teeter do to improve our products and/or services?
(2000 character limit)
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