Site Survey

We award two free UltraTouch seats a month. Fill out our quick survey for a chance to win!

Name:
Occupation:
Male:  Female: 
City:
State:
Email Address:
   
1. How did you find out about the UltraTouch toilet seat?
(check all that apply)
a: TV  , which station: 
b: Magazine  , which one: 
c: Seen it in the store  , which store: 
d: Other: 
 

2. How many toilets in your home?
1    2    3    More

 
3. When was the last time you bought a toilet seat?
1 year    2 - 5 years    5 or more years ago
 
4. When making a decision to purchase a toilet seat, select the following items in order of importance to you.
Items:
Your Choices:
 
Most Important
 
 
 
Least Important
 
5. Has our information answered all of your question?
Yes No , what more would you like to know: 
 
6. Product and Specials Notification
Please notify me of important product information and specials:
Our list is kept private and we will not send more than 4 emails per year
 
Comments:
 




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