Title
DR
MISS
MR
MRS
MS
First Name
•
Last Name
•
Email Address
•
Home Address
•
City
•
State
•
ZIP / Postal Code
•
Country
-- Select Country --
AFGHANISTAN
ALAND ISLANDS
ALBANIA
ALGERIA
AMERICAN SAMOA
ANDORRA
ANGOLA
ANGUILLA
ANTARCTICA
ANTIGUA AND BARBUDA
ARGENTINA
ARMENIA
ARUBA
AUSTRALIA
AUSTRIA
AZERBAIJAN
BAHAMAS
BAHRAIN
BANGLADESH
BARBADOS
BELARUS
BELGIUM
BELIZE
BENIN
BERMUDA
BHUTAN
BOLIVIA
BOSNIA AND HERZEGOVINA
BOTSWANA
BOUVET ISLAND
BRAZIL
BRITISH INDIAN OCEAN TERRITORY
BRUNEI DARUSSALAM
BULGARIA
BURKINA FASO
BURUNDI
CAMBODIA
CAMEROON
CANADA
CAPE VERDE
CâTE D'IVOIRE
CAYMAN ISLANDS
CENTRAL AFRICAN REPUBLIC
CHAD
CHILE
CHINA
CHRISTMAS ISLAND
COCOS (KEELING) ISLANDS
COLOMBIA
COMOROS
CONGO
CONGO, THE DEMOCRATIC REPUBLIC OF THE
COOK ISLANDS
COSTA RICA
CROATIA
CUBA
CYPRUS
CZECH REPUBLIC
DENMARK
DJIBOUTI
DOMINICA
DOMINICAN REPUBLIC
ECUADOR
EGYPT
EL SALVADOR
EQUATORIAL GUINEA
ERITREA
ESTONIA
ETHIOPIA
FALKLAND ISLANDS (MALVINAS)
FAROE ISLANDS
FIJI
FINLAND
FRANCE
FRENCH GUIANA
FRENCH POLYNESIA
FRENCH SOUTHERN TERRITORIES
GABON
GAMBIA
GEORGIA
GERMANY
GHANA
GIBRALTAR
GREECE
GREENLAND
GRENADA
GUADELOUPE
GUAM
GUATEMALA
GUINEA
GUINEA-BISSAU
GUYANA
HAITI
HEARD ISLAND AND MCDONALD ISLANDS
HOLY SEE (VATICAN CITY STATE)
HONDURAS
HONG KONG
HUNGARY
ICELAND
INDIA
INDONESIA
IRAN, ISLAMIC REPUBLIC OF
IRAQ
IRELAND
ISRAEL
ITALY
JAMAICA
JAPAN
JORDAN
KAZAKHSTAN
KENYA
KIRIBATI
KOREA, DEMOCRATIC PEOPLE'S REPUBLIC OF
KOREA, REPUBLIC OF
KUWAIT
KYRGYZSTAN
LAO PEOPLE'S DEMOCRATIC REPUBLIC
LATVIA
LEBANON
LESOTHO
LIBERIA
LIBYAN ARAB JAMAHIRIYA
LIECHTENSTEIN
LITHUANIA
LUXEMBOURG
MACAO
MACEDONIA, THE FORMER YUGOSLAV REPUBLIC OF
MADAGASCAR
MALAWI
MALAYSIA
MALDIVES
MALI
MALTA
MARSHALL ISLANDS
MARTINIQUE
MAURITANIA
MAURITIUS
MAYOTTE
MEXICO
MICRONESIA, FEDERATED STATES OF
MOLDOVA, REPUBLIC OF
MONACO
MONGOLIA
MONTSERRAT
MOROCCO
MOZAMBIQUE
MYANMAR
NAMIBIA
NAURU
NEPAL
NETHERLANDS
NETHERLANDS ANTILLES
NEW CALEDONIA
NEW ZEALAND
NICARAGUA
NIGER
NIGERIA
NIUE
NORFOLK ISLAND
NORTHERN MARIANA ISLANDS
NORWAY
OMAN
PAKISTAN
PALAU
PALESTINIAN TERRITORY, OCCUPIED
PANAMA
PAPUA NEW GUINEA
PARAGUAY
PERU
PHILIPPINES
PITCAIRN
POLAND
PORTUGAL
PUERTO RICO
QATAR
REUNION
ROMANIA
RUSSIAN FEDERATION
RWANDA
SAINT HELENA
SAINT KITTS AND NEVIS
SAINT LUCIA
SAINT PIERRE AND MIQUELON
SAINT VINCENT AND THE GRENADINES
SAMOA
SAN MARINO
SAO TOME AND PRINCIPE
SAUDI ARABIA
SENEGAL
SERBIA AND MONTENEGRO
SEYCHELLES
SIERRA LEONE
SINGAPORE
SLOVAKIA
SLOVENIA
SOLOMON ISLANDS
SOMALIA
SOUTH AFRICA
SOUTH GEORGIA AND THE SOUTH SANDWICH ISLANDS
SPAIN
SRI LANKA
SUDAN
SURINAME
SVALBARD AND JAN MAYEN
SWAZILAND
SWEDEN
SWITZERLAND
SYRIAN ARAB REPUBLIC
TAIWAN, PROVINCE OF CHINA
TAJIKISTAN
TANZANIA, UNITED REPUBLIC OF
THAILAND
TIMOR-LESTE
TOGO
TOKELAU
TONGA
TRINIDAD AND TOBAGO
TUNISIA
TURKEY
TURKMENISTAN
TURKS AND CAICOS ISLANDS
TUVALU
UGANDA
UKRAINE
UNITED ARAB EMIRATES
UNITED KINGDOM
UNITED STATES
UNITED STATES MINOR OUTLYING ISLANDS
URUGUAY
UZBEKISTAN
VANUATU
VENEZUELA
VIETNAM
VIRGIN ISLANDS, BRITISH
VIRGIN ISLANDS, U.S.
WALLIS AND FUTUNA
WESTERN SAHARA
YEMEN
ZAMBIA
ZIMBABWE
•
Home Phone Number
•
Mobile Phone Number
Enter Word Verification in box below
•
Are you:
Male
Female
Married
Age:
Do you:
Own
Rent
Your:
Condo
Apartment
Home
Townhouse
Your Annual Household Income:
Under $20,000
$21,000 - $35,000
$36,000 - $60,000
Over $60,000
1. Did you purchase an International Bedding "IB" •
Complete Sleep Set
Mattress Only
2. Which Model?
•
3. Which Size?
King
Queen
Full
Twin
4. What was the total purchase price?
$ •
5. When did you purchase?
•
6. Dealer Name:
•
City:
State:
7. Why did you purchase an IB sleep system? •
Exceptional Value
Patented exclusive features/benefits
Special dealer price
World-Wide Warranty
Advertising
Newspaper
TV
Radio
Other
Store Salesperson
Referred by relative or friend
Referred because:
Who helped you select IB?
Wife
Husband
Fiancé
Friend
Other:
8. Is this the first IB sleep system you have purchased? •
Yes
No
9. If yes, what brand sleep set or mattress did you previously own?
Brand
Model
10. How long did you own it?
11. What problems, if any, did you have with your old sleep set?
12. If no, how many years did you own your last IB?
13. Of all the IB features/benefits, which ones most influenced your purchase (Please rate 1-9 in order of preference):
IB World-Wide Reputation
-- Please select --
1
2
3
4
5
6
7
8
9
Lumbar Support Zone
-- Please select --
1
2
3
4
5
6
7
8
9
IB Patented MIRA-COIL Continuous Wire Spring
-- Please select --
1
2
3
4
5
6
7
8
9
Modular DBR Base
-- Please select --
1
2
3
4
5
6
7
8
9
IB Limited Warranty
-- Please select --
1
2
3
4
5
6
7
8
9
Comfort
-- Please select --
1
2
3
4
5
6
7
8
9
Firmness
-- Please select --
1
2
3
4
5
6
7
8
9
I prefer:
Ultra Firm
Extra Firm
Firm
Gently Firm
Exclusive DBR guard-border support system
-- Please select --
1
2
3
4
5
6
7
8
9
Other
-- Please select --
1
2
3
4
5
6
7
8
9
(Please specify):
14. Did you have any problems with your purchase? (Please specify)
15. Would you recommend an IB sleep system to a friend?
Yes
No
16. Why?