VIBETRONICS | Mail-in Registration Form

A REGISTRATION NUMBER WILL NOT BE CREATED IF REGISTRATION IS COMPLETED WITHOUT AN EMAIL ADDRESS. ALL INFORMATION WILL BE REGISTERED WITHOUT WEB SUPPORT.

California Exotic Novelties Product Registration

First Name:

____________________________________________________________________

Last Name:

____________________________________________________________________

Address:

____________________________________________________________________

Street City State Zip

Phone:

____________________________________________________________________

E-mail:

____________________________________________________________________

Product Purchased:

____________________________________________________________________

Item Number Product Name

Date of Purchase:

____________________________________________________________________

Month / Day / Year Place of Purchase

To help us better serve your needs in the future, please answer the following questions to complete
this registration process (answers are strictly confidential).

Age: _____________

Sex: _____________

Marital Status: _____________

Income per year:	10,000 - 19,999	_________
	20,000 - 30,000	_________
	31,000 - 40,000	_________
	41,000 - 50,000	_________
	51,000 - 75,000	_________

Would you like information on other California Exotic Novelties products?

Yes: _____

No: _____

Do you have any suggestions or comments you would like to share with us?

___________________________________________________________________________________

  Mail To:
  VIBETRONICS
  P.O. Box 5108
  Chino, CA 91708