1-year warranty

*Product	InvertAlign
*Serial Number	*On the back of the main shaft housing
*Date of Purchase
*Dealer Name	Costco Warehouse
*First Name
*Last Name
*Address
*City
*State
*ZIP/Postal Code
*Country
Phone Number (optional)
* required for warranty

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Please complete the information below, though it is not essential for the validation of the warranty.  All data is strictly confidential.

Age?  :: - - - - - - - - - - Under 18 18-25 26-35 36-45 46-55 Over 55

Gender?  ::  Female Male

Income (household) ::
- - - - - - - - - - Under $26,000 $26,000 - 35,000 $35,001 - 55,000 $55,001 - 75,000 $75,001 - 100,000 Over $100,000   

Primary reason for purchasing product :: - - - - - - - - - - Relief/Prevention of Back Pain Decompress After Exercise Increase Abdominal Strength Overall Health (Improve Circulation, Stay Young) Reduce Stress/Relaxation

How frequently do you exercise (walking, jogging, weight lifting, sports, etc.)? :: - - - - - - - - - - Every day 3-4 times per week 1-2 times per week A few times per month Never

Please rank the following items in order of importance in your purchasing decision: (1=most important; 5=least important)
Educational Materials  Retailer Demonstration 
Price  Warranty  Product Quality

How did you learn about inversion therapy? ::
- - - - - - - - - - Select Here Friend Internet Used prior to 1985 Retailer/Catalog Medical Professional Television/Magazine Other if other, please name:

Did you review the web site prior to purchasing? ::
- - - - - - - - - - Yes No

What feature interested you the most about the InvertAlign? ::
- - - - - - - - - - Overall design Large support handles Padded bed Traction handles Ratchet ankle system Lumbar pillow

Did you find the Assembly Instructions and Owner's Manual clear and helpful ? ::
- - - - - - - - - - Yes No

Please tell us about your experience with the InvertAlign ::