Warranty registration form

Fields marked with * are mandatory.

Your information First name*

Last name*

Sex* M F
Address*

City*

Province/state*
Postal/zip code*

Telephone*

Birth date*
Email*

Language* French English

Bike's information Model name*

Serial number*

Color*

On all bicycles, the serial number can be found under the left chainstay. This number has 10 or 11 digits(bar code number).

Dealer's information Store name*

Province*
Date of purchase*

General survey 1. Why did you choose this brand and model? (1 answer and +)* Price Services and warranty Specifications Made in Canada
Friend's recommendation Brand reputation Look and design Quality-price
Comfort Others

2. How often do you usually ride?* Everyday 3 times a week On weekends Once a week Once a month

3. What is you gross family income?* - 19 999 $ 20 000 $ - 29 999 $ 30 000 $ - 39 999 $ 40 000 $ - 49 999 $ 50 000 $ - 59 999 $
60 000 $ - 69 999 $ 70 000 $ +

4. Education* High school CEGEP (Qc) College

5. Why do you bicycle? (max 2 choices)* For fun To discover places For fitness To compete
For transportation Four outing For family activity

6. What other sports do you do?* Running Camping Cross-country skiing Downhill skiing
Snowboarding Inline skating Swimming Walking
Weight training Others

7. Where do you get your information on cycling?* Bicycles magazines Stores The internet Other cyclists
Races Bike shows Flyers Circulars
Friends Others

8. When do you foresee buying another bicycle?* Less than a year from now 1-2 years from now 3-4 years from now 5 or more years from now

9. I wish to receive more informations about Miele.* Yes No

10. I wish to subscribe to the Miele maling list.* Yes No

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