Thank you for purchasing this Jimmyjane product. Answering the following questions will register your product and help us bring more innovative products to you.
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| First Name : |
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| Last Name : |
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| Street : |
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| Apt. # : |
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(include country code) |
| Product purchased: |
FORM 2
FORM 3
FORM 4
FORM 6
HELLO TOUCH
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| Purchase Date : |
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(Month/Day/Year)
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| Identification Number: : |
(How do I find it?) |
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| Did you purchase this product for yourself or did you receive it as a gift? |
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Purchased for myself
Gift
Other :
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| Where was the product purchased from? |
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Retail Store
Catalog
Website :
Other :
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| What is the gender of the product's primary user? |
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Female
Male
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| What is your age group? |
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18-24
25-34
35-44
45-54
55-64
65 +
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| Which group describes your family's annual income? |
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Under $25,000
$25,000 - $49,999
$50,000 - $74,999
$75,000 - $99,999
$100,000 - $149,999
$150,000 or higher
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| What factors influenced your decision to choose this product? (check a maximum of three) |
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Innovation/Special Features
Style/Appearance/Design
Massage Capabilities
Warranty/Service
Quality/Durability
Ease of Operation
Friend's/Relative's Recommendation
Salesperson's Recommendation
Other :
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| How did you hear about Jimmyjane? |
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Magazine/Newspaper
TV/Radio
Retail Location
Family/Friend
Website :
Other :
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| Overall, how satisfied are you with your Jimmyjane vibrator? |
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Very Satisfied
Somewhat Satisfied
Somewhat Dissatisfied
Very Dissatisfied
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| What do you like best about your Jimmyjane vibrator? |
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| What new features or product changes would improve your product experience? |
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| Enter email to receive Jimmyjane newsletter : |
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