EMP Tek Product
On-line Registration Form
  First Name Last Name E-mail Daytime Phone

Address City State Zip Country

Products purchased (if you have purchased a system or multiple products, list each serial #)
Model No. Serial No. (if available)

Where did you acquire this/these EMP Tek product(s)?
Date of purchase Dealer Name

Who installed your EMP Tek product?
Dealer/Professional Installed Myself A Friend Other 

What influenced your purchase of this EMP Tek product? (please check all that apply)
EMP Tek Reputation Recommendation of dealer Technical Specifications
Sound Quality Recommendation of family/friend Value for price
Appearance Magazine review Prior experience with EMP Tek

What other brands did you consider?

Where did you hear of EMP Tek? (please check one below)
Internet Word of Mouth Gift
Internet Advertisement Dealer It Came With My House
Magazine Advertisement Product Review Other 

Would you like someone from EMP Tek to contact you? (please check one below)
Yes – Contact Me By E-mail (address used above) Yes – By Telephone. (number used above)
Yes – Mail It To Me. (address used above) No Thanks.

Did you have any problems setting up or using your EMP Tek product(s)? (please check one below)
Yes (If yes, please describe the problem below) No
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