Product Registration

1. Name & Address:
   

   * Title     Dr.    Mr.    Mrs.    Ms.    Miss
   * First Name	Initial	* Last Name
   * Street	Apt. No.	* City
   * State/Province	* Zip/Postal Code
   Alabama Alaska Alberta American Samoa Arizona Arkansas Armed Forces AA Armed Forces AE Armed Forces AP British Columbia California Colorado Connecticut Delaware District of Columbia Micronesia-FSM Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Manitoba Marshall Islands Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Brunswick New Hampshire New Jersey New Mexico New York Newfoundland North Carolina North Dakota Northern Mariana Is. Northwest Territories Nova Scotia Nunavut Ohio Oklahoma Ontario Oregon Palau Pennsylvania Prince Edward Island Puerto Rico Quebec Rhode Island Saskatchewan South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming Yukon International
   * E-mail Address

 
2. Your date of birth:   Month January February March April May June July August September October November December Day 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
   
  
3. Date of purchase:  Month January February March April May June July August September October November December Day 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Year 2023 2022 2021 2020 2019 2018 2017 2016 2015 2014
 
4. UPC Number (the barcode number located on product package):
   
 
5. Store or website where purchased:
   
  
6. How did you first become aware of this product?
    

   Received as a Gift Advertisement Social Media Internet Magazine/Blog Article

   Newspaper/Flyer Recommendation of Friend/Family Saw Product in Store Search Engine Other:

 
7. Check the two (2) most important reasons influencing your purchase of this Hawaiian Shaved Ice product:
    

   Received as a Gift Special Offer Ease of Operation Product Features Style/Appearance Quality/Durability Hawaiian Shaved Ice Reputation

   Value for Price Recommendation of Friend/Family Recommendation of Salesperson Saw in Magazine/Blog Prior Experience with Hawaiian Shaved Ice Only Brand Available

     
8. What color are most of your small appliances?
    

   White Black Stainless with White Accents

   Stainless with Black Accents Other:

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