Product Registration Form

Thank you for purchasing the Nurse-n-Glow™ pillow. Below please provide us with some basic information in order to activate your 1 year limited warrantee.

The following information will help us with our research & development of future products.

Last Name

First Name

Address 

City 

State

Zip

Phone Number

Email Address

How did you receive the Nurse-n-Glow™ Pillow? Gift Self purchase Baby registry

What store or catalog was it purchased from?

Are you a first time mother? Yes No

If no, how many children do you have?  

How long do you plan to nurse?

What is your age?  

Annual Household income  $20,000 or Less $20,000 - $35,000 $36,000 - $50,000 $51,000 - $75,000 $76,000 - $100,000 $101,000 or above

Before owning a Nurse-n-Glow™ pillow, did you nurse in bed? Yes No

How did you find out about the Nurse-n-Glow pillow?

If you have tried your Nurse-n-Glow™ pillow, please provide us with any additional comments you would like us to know:

Thank you for taking the time to answer our survey. If you have any questions please feel free to contact us at any time. Also, please browse through our website. We pride ourselves on providing you with a great source for information on breastfeeding. There are many links to will bring you to other websites that contain pertinent information regarding parenting, nursing, infant care etc. Our store supplies a variety of nursing necessities and books in addition to our pillow.

Privacy Statement:
Bela Baby is committed to keeping any information we receive from our users private and secure. We do not sell our customer information to any outside company. All information collected remains private and secure.