Customer Information
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| First Name * | |
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| Last Name * | |
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| Company Name | |
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| E-mail * | |
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| Phone Number | |
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| Address * | |
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| Apt/Suite/Floor | |
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| City * | |
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| ZIP * | |
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| Country * | |
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| State * | |
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| Where did you purchase this Tanita Product? | |
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| Where did you hear about us? | |
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| Did you receive this Tanita product as a gift? | |
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| Will you primarily use this Tanita product to monitor your | |
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| How many people in your household will regularly use the body fat monitoring function? | |
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| How satisfied are you with each the following Tanita product attributes? | |
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| Product design | |
| Overall satisfaction | |
| Weight capacity | |
| Features | |
| Ease of use | |
| Accuracy | |
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| How likely are you to recommend Tanita to your family and friends? | |
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| Internet survey |
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| Telephone survey |
| Mail survey |
| Testimonials |
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| Tanita body fat / body composition monitors |
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| Tanita kitchen scales |
| Tanita hand-held healthcare products |
| Other, specify |
| Any additional comments or remarks? | |
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About You
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| Your gender | |
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| Your age | |
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| Your highest level of education | |
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| Your annual household income | |
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| Approximate number of hours you exercise in a typical week | |
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(Check all that apply.) | |
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| Swimming |
| Weight Lifting |
| Others (baseball, basketball, etc. |
| Marathons |
| Running |
| Walking |
| Aerobics |
| Triathlons |
| Bicycling |
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| Yes, I'd like to receive periodic information on fitness and health measurement to help me lead a healthier life, as well special offers on healthy lifestyle products from Tanita. |
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