Please fill out the following form and submit the results to complete your warranty registration.
Order Number:
Date Purchased:
Title: Mr. Mrs. Ms. Dr.
First Name:
Last Name:
Address:
City:
State: Alabama Alaska Arkansas Arizona California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Washington D.C. West Virginia Wisconsin Wyoming American Samoa Guam Micronesia Northern Mariana Islands Puerto Rico U.S. Virgin Islands
Zip:
Phone:
Email:
What influenced you to buy?
Convenient payment options
Received a free special offer via the mail
Salesperson Recommendation
Medical Professional Recommendation
Immediate and timely delivery offered
Convenient store location
Friends or Relative's Recommendation
Slept on bed in hotel
If other, specify
Why did you buy a bed? Needed a smaller bed Sleep Problems Bought a home Child moved to a larger bed Need a larger bed Back Problems Redesigned a new bedroom Did not have a bed Got Married Spare bed for guest
Where did you hear about us? Spouse Salesperson Newspaper Brochure & Product Information received Relative Magazine In-Store Display Friend TV In-home video Medical Professional Radio Mail
What is your marital status? Single Married Divorced Widowed
What best describes your family income? Less $25,000-$50,000 $50,000-$75,000 $75,000-$100,000 more than $100,000
Who made the primary decision in purchasing your mattress? Male Female Both
What are the age ranges of the primary users of the bed? Under 25 25-30 31-35 36-44 45-55 56-64 65 and over
What size mattress did you purchase? Twin Twin Long Double Double Long Queen Split Queen King California King
When will you be purchasing a second mattress/bed? Within 12 months Within 24 months No plans
What source of information helped you the most in selecting your product? Spouse Salesperson Newspaper Brochure & Product Information received Relative Magazine In-Store Display Friend TV In-home video Medical Professional Radio Mail
What other brands did you consider before making your purchase?
Simmons
Sealy
Serta
Spring Air
King Koil
Only Tempur-Pedic
Where did you buy your mattress? Directly from Tempur-Pedic Retail Store Medical Health Professional
If purchased through retail store, please specify:
How long did you spend gathering information and shopping for this purchase? Weeks Months
How satisfied were you with the sales services you received? 1 being very dissatisfied, 10 being very satisfied 1 2 3 4 5 6 7 8 9 10
Please rate the following with respect to your sales experience:
Level of professionalism: (1 being very unprofessional, 5 being very professional) 1 2 3 4 5
Level of courteousness: (1 being very discourteous, 5 being very courteousness) 1 2 3 4 5
Level of knowledge: (1 being very unknowledgeable, 5 being very knowledgeable) 1 2 3 4 5
What service level of delivery did you choose? Express (10 days, dropped on doorstep) Full Service (21 days, in-home delivery and set up)
Within the bounds of the above-referenced delivery times, was your order delivered in a timely manner? Yes No
If "no", please explain:
Name of the delivery service, if known.
Did your delivery personnel set up the product to your satisfaction? (only if full service) Yes No
Were the delivery personnel professional and courteous? Yes No
Did the delivery personnel seem to be knowledgeable about the product? Yes No
Please rate your overall satisfaction with your delivery. (1 being very dissatisfied, 5 being very satisfied) 1 2 3 4 5
Are you happy with the Tempur-Pedic, Inc. products you purchased? (1 being very dissatisfied, 5 being very satisfied) 1 2 3 4 5
Would you order Tempur-Pedic products in the future? Yes No
Would you recommend our products? Yes No
If you have contacted Tempur-Pedic's Customer Service how would you rate your experience? (1 being very dissatisfied, 5 being very satisfied) 1 2 3 4 5
Comments:
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