* Indicates required field
*Title
*First Name
Middle Initial
*Last Name
*Address Line 1
Address Line 2
*City
*Country/State
*Zip / Postal Code
*Email Address
*Age  
  PLEASE NOTE: Individuals under the age of 18 are not allowed to register products or sign up for promotional offerings.
Marital Status Married Single
   
*Date of Purchase: Click for Calendar Click for Calendar
  (format: mm-dd-yyyy)
If you are having problems accessing the calendar function, please click here, to enter the date manually.
 
*Model Number:
(from package)
 
*Serial Number:
(example: C1234567)
 
*Store where purchased:  
*Price Paid:
$ 

(rounded to the nearest dollar)

What were your primary reasons for purchasing this product?
(Check all that apply.)
Allergies/Asthma Colds/Flu
General Health Concerns General Home Environment Concerns
New Baby/Child in Household General Odor Concerns
Pet Odors Tobacco/Smoke Odors
Kitchen Odors Bathroom Odors
Baby Odors Store Ad/Display/Promotion
Impulse Purchase Other (please specify)
     
       
How often do you use/anticipate using this product?
Continuously Once a Day
2-3 Times Per Week Once a Week
2-3 Times Per Month Once a Month
Only as Needed Other (please specify)
     
       
Which group describes your annual family income?
Under $15,000 $15,000-$19,999
$20,000-$29,999 $30,000-$39,999
$40,000-$49,999 $50,000-$59,999
$60,000-$74,999 $75,000-$99,999
$100,000-$124,999 $125,000-$149,999
$150,000-$174,999 $175,000-$199,999
$200,000-$249,999 $250,000 & over
   
 
Yes No May we contact you regarding new products or promotional offerings for Filtrete™ brand products and other brands from 3M.