Registration form

*required fields / Information will remain confidential

*Email
*First Name
*Last Name
*Address
*Serial number
*Vacuum model
Promotional Code (if applicable)
Air Miles #

*Product use
*City
*State
*Postal/Zip code
*Country
Phone
*Purchase date
Price paid
Retailer
Residential
Commercial
Are you satisfied with your retailer's services?
Yes
No
If not, please explain

Is someone in your home suffering from allergies?
Yes
No
Do you have pets at home?
Yes
No
Number of residents in your house
On average, how often do you use your vacuum cleaner?
What percentage of your home's surfacing has carpet?
To help us better understand your lifestyle
Age
Select the three most important factors which led you to choose a Cyclo Vac product
The CYCLO VAC reputation
the style, color or appearance
Your first experience with CYCLO VAC
The price or a special promotion
Recommended by a friend or a family member
Special features
TV publicity
Ease of use
Magazine publicity
Warranty / quality / durability
Newspaper publicity
Exhibitions (fairs, sales shows)
Yes, I wish to receive goods and services offers once a year.