EMP Tek Product On-line Registration Form

EMP Tek Product
On-line Registration Form

Salutation	First Name	Last Name	E-mail	Daytime Phone

Address	City	State	Zip	Country

Products purchased (if you have purchased a system or multiple products, list each serial #)
Model No.	Serial No. (if available)

Where did you acquire this/these EMP Tek product(s)?
Date of purchase	Dealer Name

Who installed your EMP Tek product?
Dealer/Professional	Installed Myself	A Friend	Other

What influenced your purchase of this EMP Tek product? (please check all that apply)
EMP Tek Reputation	Recommendation of dealer	Technical Specifications
Sound Quality	Recommendation of family/friend	Value for price
Appearance	Magazine review	Prior experience with EMP Tek

What other brands did you consider?

Where did you hear of EMP Tek? (please check one below)
Internet	Word of Mouth	Gift
Internet Advertisement	Dealer	It Came With My House
Magazine Advertisement	Product Review	Other

Would you like someone from EMP Tek to contact you? (please check one below)
Yes – Contact Me By E-mail (address used above)	Yes – By Telephone. (number used above)
Yes – Mail It To Me. (address used above)	No Thanks.

Did you have any problems setting up or using your EMP Tek product(s)? (please check one below)
Yes (If yes, please describe the problem below)	No