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1. PLEASE PRINT
First Name M.I. Last Name
Address Apt. No.
City State Zip Code
Phone
(
)
E-mail Address
2. Serial Number:
3. Model Number:
4. When did you purchase your grill? Month Day Year
5. Without tax, how much did you pay for it? $_________.00
Thank you for purchasing a Ducane
®
Affinity
®
S
™
gas grill. Completing the information on this
form will allow us to contact you on matters related to your grill. Thank you very much for
providing the information below.
Note: Often times when you fill out a form like this, you end up receiving unwanted solicitations from companies you
don’t know. We respect your privacy. We will not sell, rent, or distribute your name, address, or personal information
to other companies at any time. This information will only be used in the event we need to contact you and for
market research purposes.
08/01/06
8. Which best describes your interest in grilling?
I’m a grilling fanatic I moderately enjoy grilling
I enjoy grilling very much, but I’m not fanatical about it I’m only marginally interested in grilling
Knowing more about who buys our grills helps us develop new and innovative products. Please
complete the questions you feel comfortable answering, and pass by any question you prefer to
leave blank. Again, this information is not sold or rented.
9. Gender: Male Female
10. Marital Status: Married Single
11. Date of Birth: Month Day Year
12. Including yourself, how many people live in your household?
Adults Children
13. What are the ages of the children living at home?
Age 2 and under Age 5 to 12
Age 3 to 4 Age 13 to 17
14. Do you own or rent a home? Own Rent
15. What is the highest level of education you completed?
Some high school Earned a college degree
Earned a high school diploma Earned a graduate degree
6. Is this grill. . .
The first grill you have ever owned? A replacement for an old or broken gas grill?
A replacement for an old or broken charcoal grill? An additional grill for your household?
16. What is your total annual household income?
Under $15,000 $35,000 – 39,999 $60,000 – 74,999 $175,000 – 199,999
$15,000 – 24,999 $40,000 – 44,999 $75,000 – 99,999 $200,000 – 249,999
$25,000 – 29,999 $45,000 – 49,999 $100,000 – 149,999 $250,000 – 299,999
$30,000 – 34,999 $50,000 – 59,999 $150,000 – 174,999 $300,000 or more
17. Which activities or interests do you enjoy?
Arts/antiques Camping/hiking Needlework Attending cultural arts/events
Biking/bicycling Foreign travel My cat Shopping by mail order/catalog
Boating/sailing Gardening/plants My dog Listening to music on my CD player
Buying videos Veterans’ affairs Snow skiing Listening to music on any device
Walking Politics Stocks and bonds Physical fitness/exercise
Fishing The grandchildren Personal computers Subscribing to cable TV
Running Houseplants Photography Watching sports on TV
Dieting Hunting Tennis Other ____________________
Golf Motorcycles Donating to charity
RNS01-01
7. What brand of grill did you own most recently?
This is the first grill I have owned Weber charcoal grill Thermos gas grill
Ducane gas grill Weber gas grill Fiesta gas grill
Ducane portable grill Char-Broil gas grill Other ____________________
Weber portable grill Sunbeam gas grill
Register your grill online at www.ducane.com. (If you register online, you do not need to send in this registration card.)