Prefix:
-- Mr. Mrs. Ms. Miss

*First Name:

MI

*Last Name:

Gender:
Male:  Female: 

Marital Status:
Select One: Married Single Separated Divorced Widowed

Age:
Select One: Under 35 36-45 46-55 56-65 Over 65

*Address 1:

Address 2:

*City:

*State:
-- AL AK AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY

*Zip:

Home Phone:

Alternate Phone:

Email Address:

*Date of Purchase:
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 / Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec / 2008 2007 2006 2005 2004 2003

*Serial Number:

*Model:
Select One: Elevate™ 2 Source, 4 Zone Amplifier BA-2430S Elevate™ 6 Source, 6 Zone Amplifier BA-6640 Power Unit BA-2430DA Elevate Installation Kit BA-2430IK Add-a-Room BA-2430KP Retail Convenience Pack BA-2430PKG 1 Pair 6.5” Resonate In-Ceiling Speakers BA-650C 1 Pair 6.5” Resonate In-Wall Speakers 6.5” Resonate In-Ceiling Single Stereo Speaker BA-650CS 1 Pair Outdoor Rock Speakers, Granite BA-650RK-GT 1 Pair Outdoor Rock Speakers, Sandstone BA-650RK-SA Pulse™ 200 Watt Auxiliary Amplifier BA-200 Learning Remote Control BA-LRC1 Allport™ Tester BA-AWT1

*Store/Dealer Purchased From:

Primary Reason for Purchase:
Select One: I saw the system at my local retailer I’m retrofitting into my existing home I heard my neighbor’s/friend’s BreatheAudio system It was offered as an option from my builder I'm building a new home and requested BreatheAudio

What was the source that influenced your purchase decision?
Select One: Internet search or advertisement Magazine advertising Newspaper advertising In-store display TV advertisement Special offer Recommended by a friend Recommended by a salesperson Value for price Superior sound quality Style and appearance Warranty and service Product features Ease of operation Received as a gift

Including you, number of people in the household?
Select One: 1 2 3 4 5 6 7 8 9 10 10+

Which best describes the value of your home?
Select One: Under $75,000 $75,000-$149,999 $150,000-$249,999 $250,000-$399,999 $400,000-$649,999 $650,000-$799,999 $800,000-$949,999 $950,000-$1.49million $1.5million or over

How many rooms (including bathrooms) do you have in your home?
Select One: 1 2 3 4 5 6 7 8 9 10 10+

What is the approximate Square Footage of your home?
Select One: Under 1000sf 1000-2000sf 2000-3000sf 3000-5000sf Over 5000sf

Which best describes your family income?
Select One: Under $35,000 $35,000-$49,999 $50,000-$99,999 $100,000-$124,999 $125,000-$174,999 $175,000-$199,999 $200,000-$249,999 $250,000-$299,999 $300,000 or over

What is your favorite audio to listen to?
Select One: Alternative Audiobooks Bluegrass Broadway/Show Tunes Children's Music Christian Rock Classical Country Dance/Electronic Folk Music Gospel Jazz Latin/Salsa New Age Pod Casts/News Pop/Top 40 Rock/Heavy Metal Reggae/Island Rap/Hip Hop Rhythm & Blues Sports Talk Radio World Music