DYNO KRUISERS

Complete your Warranty Card online
by filling out the following form.

Mr. Mrs. Ms. Miss

First Name:

Initial:

Last Name:

Address: (Number and Street)

Apt #:

City:

State:

Zip:

Country:

Email Address: (Ex: name@abc.com)

Phone Number:
( ) - -

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Date of Purchase: (mm / dd / yyyy)
/ /

Dealer Name:

Purchase Price:
$ .00

Brand Purchased

Wheel Size

Model Purchased:

(Example: Pro Freestyle Tour)

Serial Number:

Date of birth:(mm / dd / yyyy)
/ /

Education:

Which best describes your family income?

Your marital status:
Married Single

For your primary residence, do you:
Own Rent

Including yourself, what is the total number of people living in your household?

NOT including yourself, what are the AGES of the other people living in your household?

Males

Month	Year

Females

Month	Year

In the last 6 months have you or your spouse:

	Purchased clothes through the mail?
	Purchased gifts through the mail?
	Worked in your garden?
	Traveled on vacation?
	Purchased a PC or PC software?

	Purchased two or more books?
	Purchased cassettes/CDs?
	Donated to wildlife/environmental causes?
	Donated to charities?

Thanks for filling out this questionnaire. Your answers are important to us. Please check the box on the left if you do not wish to learn more about gtbikes or obtain information on new and interesting opportunities.