For the LOVE of COOKING Promotion

Name *

First Last

Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country

Phone *

### - ### - ####

Email *

Purchase Date *

MM / DD / YYYY

Promotion Dates: January 1 through March 31, 2014

Store Name *

Store Type *

Cooktop Model Number *

Cooktop Serial Number *

Serial # is located on the bottom of the rough-in box and the shipping carton.

Redemption Code (if provided) *

(Optional)

Date of Birth

MM / DD / YYYY

Marital Status

Single

Married

What was the primary reason you chose Wind Crest Ventilation? *

What was the secondary reason you chose Wind Crest Ventilation? *

Was Wind Crest
Recommended by: *

Salesperson

Family/Friend

Designer

Other

Was the decision maker?:

Female

Male

Joint Decision

Other

New Products and Special Promotions

Yes, please inform me of the latest products and pormotions

No, do not sign me up for any email updates

Product Announcements

Yes, please send me updates about my products

No, I do not wish to receive any information