Product Registration

First Name: *
Last Name: *
Mailing Address: *
City: *
State/Province: *	Select a State Alabama Alaska Alberta Arizona Arkansas British Columbia California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Manitoba Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Brunswick New Hampshire New Jersey New Mexico New York Newfoundland North Carolina North Dakota Northwest Territories Nova Scotia Nunavut Ohio Oklahoma Ontario Oregon Pennsylvania Prince Edward Island Quebec Rhode Island Saskatchewan South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Yukon Territory
Zip/Postal Code: *
Country: *	Select a Country Canada United States
Phone: *
Email: *
Date Purchased: *
Place Purchased: *	MosquitoMagnet.com Ace Hardware Amazon Aubuchon Hardware Barbecue.com As a Replacement Home Depot Lowe's Sears True Value Hardware Do It Best Club Store Other Retail Other Catalog Other Online Don't Know
Model: *	Defender Liberty Patriot Liberty Plus Independence Executive Other
Serial Number: *
Find it on the back of the top of the trap. Should be 15 digits long

What will your trap be used for?

Home    Commercial

How did you find out about the Mosquito Magnet® (check all that apply)?

Radio Ad
Friend/Family
Newspaper Ad
Direct Mail
Website
News Article (newspaper, magazine, TV, etc)
In Store Display
TV Ad
Magazine Ad

In your household, who decided to purchase the Mosquito Magnet®?

Husband    Wife    Other

What is your maritial status?

Married    Single

Are there any children in your household?

Yes    No

What are the two most important reasons influencing this purchase?

Science/technology behind product
Recommendation of friend/family member
Recommendation of salesperson
Reputation of quality
Protection from disease
Comfort
Received as gift
Other

What is your age?

25-35
36-45
46-55
56-65
66+

What is your level of education?

High School Diploma
College Degree
Graduate Degree
Doctoral Degree
Technical/Professional

What best describes your yard size (in acres)?

1/4-1/2
1/2-3/4
3/4-1
1-2

What is your annual income?

$25,000-40,000
$40,000-60,000
$60,000-90,000
Over $90,000

What other brands of insect abatement have you tried?

Zappers Sprays Pesticides Other

Would you consider giving a testimonial once you are thoroughly convinced of the effectiveness of the Mosquito Magnet®?

Yes    No

Would you recommend the Mosquito Magnet® to a friend?

Yes    No

Were the assembly directions and operation instructions printed clearly and simply?

Yes    No

Did you require customer service?

Yes    No

Yes! I want to receive future communications, including promotions and updates, from Mosquito Magnet®.