Four Power Four P4 Country v2, User Manual

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CERTIFICATE OF GUARANTEE /CUSTOMER SATISFACTION ENQUIRY
– P4 COUNTRY
Please return to :
4 poWer 4
Baron de Castro 16
B-1040 Bruxelles
Belgium
Name .......................... First name .......................... Questionnaire answered on ..........................
Address ..............................................................................................................................................
Tel. N° SS N°…../………/…..…/….…/………../……./ /….../
Date of birth .............................. Height ............ Weight ......... Pathology .......................................
Wheelchair serial N° ........................
Dealer’s address ...............................................................................................................................
E-mail address ...................................................................................................................................
******************************************************
Customer Satisfaction Enquiry
Dear Customer,
You recently acquired a P4 Country Off-Road Electric Wheelchair, and we thank you for your trust in
our products. We would appreciate your remarks or suggestions as a P4 Country user. By filling in this
questionnaire and returning it to us, you will help us to match our products and services to your needs.
Is this your first off-road wheelchair ?

YES

NO
If NO, what make was the previous one ? ....................................................
Reason for changing

Wheelchair worn out

Wheelchair not adapted

Evolution of needs

Other (please specify)
Getting to know the product
1) How did you learn of our products ?

Magazine ad (which magazine ?) ..............................................................................

Recommended by :

Your dealer

Your friends & family

Demonstration in a Center. Which one ? ....................................................................

Demonstration at an Exhibition. Which one ? .............................................................

Internet

Other ..........................................................................................................................
2) Did the documentation seem to you

Insufficient

Suitable

Complete
3) Did our brochures provide you with enough technical information?

YES

NO
4) Did your dealer provide you with all the information you required concerning our wheelchair ?

YES

NO
5) Did you have a demonstration :

With the dealer

With our salesperson

Both

Neither