PRODUCT REGISTRATION
We at Century Furniture thank you for purchasing our furniture. Your retailer can assist you in many areas. We would, however, like to know more about you. Therefore, we ask you to complete the following questionnaire. This will register your purchase and you will become eligible for a drawing for Century furniture with a retail value of $1500. Please note that your responses will be used for our information purposes only. No names will be sold to outside mailing companies.

REQUIRED FIELDS IN GREEN

FIRST NAME   LAST NAME  
ADDRESS 1   ADDRESS 2
CITY   STATE    ZIP      
EMAIL OCCUPATION

YOU MAY RECORD UP TO 6 SKU NUMBERS FROM THE STICKERS INCLUDED
ON ANY PRODUCT REGISTRATION CARDS YOU RECEIVED.
 
 
RETAILER PURCHASED DATE
CITY STATE    ZIP  


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