CleanRest Warranty Registration Survey

CleanRest does not share your personal information with any third parties. We promise this to you!

Questions that are marked with a * are required and can not be left blank

3. Gender:

Gender: Female

Male

*

4. Address:

Address: Street
City
State
ZIP
Country

5. Phone
with area code

Phone with area code

6. Date of Birth


Year	Date of Birth Year

7. Email

Email

8. Have you purchased CleanRest® products in the past?

Have you purchased CleanRest® products in the past? No

Yes

Please list which products

*

9. CleanRest item(s) purchased:

CleanRest item(s) purchased: Standard Allergy Blocking Pillow

Standard/Queen Allergy Blocking Pillow

Queen Allergy Blocking Pillow

Travel Pillow

King Allergy Blocking Pillow

Standard Pillow Encasement

Standard/Queen Pillow Encasement

Queen Pillow Encasement

King Pillow Encasement

Twin Mattress Encasement

Twin XL Mattress Encasement

Full Mattress Encasement

Queen Mattress Encasement

King Mattress Encasement

California King Mattress Encasement

Twin Fitted Mattress Protector

Twin XL Fitted Mattress Protector

Full Fitted Mattress Protector

Queen Fitted Mattress Protector

King Fitted Mattress Protector

Cal King Fitted Mattress Protector

Twin Box Spring Encasement

Twin XL Box Spring Encasement

Full Box Spring Encasement

Queen Box Spring Encasement

King Box Spring Encasement

Twin Duvet Encasement

Full/Queen Duvet Encasement

King Duvet Encasement

Crib Encasement

Child/Youth Pillow

Window Drapery Panels

*

10. Where did you buy your CleanRest product(s)?

Where did you buy your CleanRest product(s)?

11. Date of purchase:

	Month	Year
Date	Date of purchase: Date Month	Year

12. What prompted your CleanRest purchase? (check all that apply)

What prompted your CleanRest purchase? (check all that apply) Have purchased CleanRest® products in the past Easy Care Fabric Color	Bed Bugs Dust mite protection Water Resistance Allergy protection	Mattress protection Breathability Pillow Protection Comfort
Other (please specify)

13. Household Income

Household Income $0 to $25,000

$26,000 to $50,000

$51,000 to $75,000

$76,000 to $100,000

$101,000 to $150,000

$150,000+

14. Whom did you purchase your CleanRest product(s) for? (Check all that apply.)

Whom did you purchase your CleanRest product(s) for? (Check all that apply.) Yourself	Entire family	Parent	Child
Other (please specify)

15. How did you hear about CleanRest?

How did you hear about CleanRest? Doctor recommended

Magazine ad

Friend

Web ad

Television ad

Walked by in-store display

Other

16. Did you purchase your CleanRest product for use in your primary residence or secondary residence?

Did you purchase your CleanRest product for use in your primary residence or secondary residence? Primary Residence

Secondary or Vacation Residence

Both

Other (please specify)