Exit Registration>> Janibell Online Product Registration Form Question Title * CLIENT CONTACT INFORMATION Name: * Company: * Address: * Address 2: City/Town: * State: * -- select state -- AL AlabamaAK AlaskaAS American SamoaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareDC District of ColumbiaFM Federated States of MicronesiaFL FloridaGA GeorgiaGU GuamHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMH Marshall IslandsMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaMP Northern Mariana IslandsOH OhioOK OklahomaOR OregonPW PalauPA PennsylvaniaPR Puerto RicoRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVI Virgin IslandsVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY Wyoming ZIP: * Country: Email Address: * Phone Number: * Question Title * CLIENT TITLE Question Title * TYPE OF BUSINESS HOSPITAL MEDICAL / DENTAL FACILITY SKILLED NURSING FACILITY ASSISTED LIVING FACILITY RESTAURANT HOSPITALITY COMMERCIAL FACILITY OFFICE RESIDENTIAL OTHER (please specify) Question Title * ORGANIZATION SIZE - NUMBER OF PEOPLE IN YOUR ORGANIZATION 1~5 5~10 10~50 50~100 100~200 200+ Question Title * FACILITY SIZE - NUMBER OF ROOMS AT YOUR FACILITY 1~5 5~10 10~50 50~100 100~200 200~300 300~500 500+ Question Title * PRODUCT(S) TO REGISTER (PLEASE ENTER NUMBER OF UNITS PER MODEL) JANIBELL M250HW JANIBELL M400DS JANIBELL M330CW JANIBELL M280BW JANIBELL M450BW JANIBELL M400BW JANIBELL M330BW JANIBELL PRIVÉ Question Title * DATE OF PURCHASE Purchased on Date Question Title * PURCHASED FROM HENRY SCHEIN XPDEX HILLYARD ROCKLER KNOBS & HARDWARE ONLINE ORGANIZING.COM PLOW & HEARTH KAPLAN EARLY LEARNING DISCOUNT SCHOOL SUPPLY BECKER'S SCHOOL SUPPLY LOUISE KOOL & GALT JANIBELL.COM OTHER (please specify) Question Title * WHICH JANIBELL FEATURES ARE THE MOST IMPORTANT FOR YOUR ORGANIZATION? ECO-FRIENDLY BIODEGRADABLE LINERS WASTE-FREE DISPOSAL CONVENIENT & EFFICIENT DISPOSAL ODOR CONTROL HANDS-FREE DISPOSAL DURABLE CONSTRUCTION ATTRACTIVE DESIGN SAVES MONEY HYGIENIC DISPOSAL CONTINUOUS LINER Question Title * HOW DID YOU HEAR ABOUT JANIBELL? ONLINE SEARCH - GOOGLE ONLINE SEARCH - YAHOO ONLINE SEARCH - BING ONLINE SEARCH - OTHER ADVERTISEMENT - CHILDCARE EXCHANGE ADVERTISEMENT - MAINTENANCE SALES NEWS ADVERTISEMENT - OTHER WORD OF MOUTH Other (please specify) Question Title * COMMENTS Done >>
