Sample Form: Product Registration

Sample - Product Registration

ABC Company

Thank you for choosing our software and registering with us. We hope you like it.

Please fill out this form so that we can keep you informed when new release is available and provide you with necessary supports.

If you have any questions, please Email us at infopoll@access.wave.ca.

Note: Marked with * are required.

1.1

What product would you like to be registered? *

Product 1	Product 2
Product 3	Product 4

1.2

Where did you download it or buy it? (Specify the store or Web Site)

1.3

How did you hear about us? *

Catalog	Direct mail	Press Review
On-line services	Retail Store	Seminar
Trade show	Word of mouth	World Wide Web
Other

1.4

Please provide us your contact information:

Name:	*
Title:
Company:	*
Address:	*
City:	*
State/province:	*
Country:	*
Post/zip code:
Phone:	*
Email:	*
Company Web Site:

1.5

Any comments and suggestions:

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