Thank you for taking the time to register your new Chamberlain® Wireless Product. By registering your product you will receive: 1.) Product Protection With the information you provide we can confirm the date of purchase of your product. This confirmation is of benefit to you, especially if your original proof of purchase is lost. 2.) Proof of Ownership Your model number and other information will be kept in our files for up to ten years. 3.) Help us Develop New Products We value your input! Your responses will help us bring you new products specifically designed to meet your needs.

1.	Title:
	Mr.  Mrs.  Ms.  Miss.

2.	First Name:

3.	Middle Initial:

4.	Last Name:

5.	Street Address:

6.	City:

7.	State:

8.	ZIP Code:

9.	Email:

10.	Month/Year of purchase:

11.	Model number:
	RWA300R RWA300RC

12.	Where did you purchase this Wireless Alert?
	Electronics Retailer Mass Merchandiser On-Line Retailer Home Center/Hardware Store Chamberlain Website Other, please specify

13.	Is this product:
	The first product of this type you have ever owned? A replacement for a similar product by Chamberlain Wireless Products A replacement for a similar product by another manufacturer? An addition to a similar product you are still using?

14.	Where will this Wireless Alert be used?
	Home Work

15.	How will this Wireless Alert be used? (Check all that apply)
	Driveway alert    Protect the perimeter of property    Protect window or doors    Other security, please specify

16.	Which of the following factors influenced your decision to purchase this Wireless Alert? (Check all that apply)
	Chamberlain Brand    In-store Signs/Information    In-Store Personnel    Price    Internet Information    Advertising    Consumer Review Magazine    Product features as mentioned on packaging

17.	In your opinion, what are the three most important product features of this Wireless Alert? (Check up to three answers) Select no more than 3.
	Easy Installation    Long Battery Life    30' range of sensor    1200' range for sensor to base communication    Ability to connect 4 sensors to single receiver    Wireless connectivity    Adjustable motion sensitivity    Weather resistant design

18.	Would you like to receive other Chamberlain offers or participate in Chamberlain consumer surveys?
	Yes No

	Thank you for taking the time to fill out this questionnaire. Your answers will be used internally for market research studies and reports. We will not distribute your information to any third parties.