Please fill out the form below to submit your warranty registration. Brand Name: Martin Hearth and Heating Model #: Serial #: Name: Address: City: State: Alabama Alaska Arizona Arkansas California Colorado Connecticut District of Columbia Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip Code: Date Purchased: January February March April May June July August September October November December 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 Phone Number: Retailer where fireplace/gas log was purchased: Name: City: State: Alabama Alaska Arizona Arkansas California Colorado Connecticut District of Columbia Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Where will the fireplace/gas log be used? Living/ Family Room Dining Room Office/Study Basement Other: Please Specify Who selected the fireplace? Male Female Both What is the population of your area? Under 50,000 50,000-100,000 100,000-250,000 Over 250,000 What is your primary source of heat? Natural Gas Propane (LP Gas) Fuel Oil Electric Wood Other: Please Specify How was the fireplace/gas log installed? Professional Installer Self Other: Please Specify Cost of fireplace/gas log: $ Cost to install: $ What type of home will the fireplace/gas log be installed? Condominium Apartment Town Home Mobile Home Single Family Home Other: Please Specify With your fireplace/gas log, did you purchase any accessories? (Check all that apply.) Blower Remote Control Cabinet Mantel How did you learn about this product? Advertising Relative or friend Store Display Other: Please Specify Age of purchaser: Under 20 yrs. 20-29 yrs. 30-39 yrs. 40-49 yrs. 50-59 yrs. 60 or over Type of store where fireplace/gas log was purchased: Hearth Products Retailer Propane Retailer Natural Gas Utility Home Center/ Builder's Supply Hardware Retailer Farm Store Other: Please Specify What motivated you to buy the fireplace/gas log? (Check all that apply.) Replace older product Hard to heat location in home Emergency back up heat Fireplace/gas log was on sale Energy savings/ high efficiency Decorative addition to the room Eliminate wood burning Heat output Other: Please Specify Buyer's total annual household income is: Less than $49,999 $49,999 to $99,999 $100,000 and over In choosing your fireplace/gas logs: Price was: Not Applicable Somewhat Important Very Important Brand name was: Not Applicable Somewhat Important Very Important Overall quality was: Not Applicable Somewhat Important Very Important Heat output was: Not Applicable Somewhat Important Very Important Log appearance was: Not Applicable Somewhat Important Very Important Warranty was: Not Applicable Somewhat Important Very Important Local service was: Not Applicable Somewhat Important Very Important Ease of installation was: Not Applicable Somewhat Important Very Important Heating Efficiency was: Not Applicable Somewhat Important Very Important Remote control operation was: Not Applicable Somewhat Important Very Important
Retailer where fireplace/gas log was purchased:
Where will the fireplace/gas log be used? Living/ Family Room Dining Room Office/Study Basement
Who selected the fireplace? Male Female Both
What is the population of your area? Under 50,000 50,000-100,000 100,000-250,000 Over 250,000
What is your primary source of heat? Natural Gas Propane (LP Gas) Fuel Oil Electric Wood
How was the fireplace/gas log installed? Professional Installer Self
What type of home will the fireplace/gas log be installed? Condominium Apartment Town Home Mobile Home Single Family Home
With your fireplace/gas log, did you purchase any accessories? (Check all that apply.) Blower Remote Control Cabinet Mantel
How did you learn about this product? Advertising Relative or friend Store Display
Age of purchaser: Under 20 yrs. 20-29 yrs. 30-39 yrs. 40-49 yrs. 50-59 yrs. 60 or over
Type of store where fireplace/gas log was purchased: Hearth Products Retailer Propane Retailer Natural Gas Utility Home Center/ Builder's Supply Hardware Retailer Farm Store
What motivated you to buy the fireplace/gas log? (Check all that apply.) Replace older product Hard to heat location in home Emergency back up heat Fireplace/gas log was on sale Energy savings/ high efficiency Decorative addition to the room Eliminate wood burning Heat output
Buyer's total annual household income is: Less than $49,999 $49,999 to $99,999 $100,000 and over
In choosing your fireplace/gas logs:
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