CONSUMER NAME:_________________________________________________________________
ADDRESS:_________________________________________________________________________
CITY: _______________________________ STATE _______________________ ZIP: _____________
DAY PHONE:_________________________E-MAIL_______________________________________
DATE OF PURCHASE: _______________ RETAILER: ___________________________________
LAKE OR AREA USED: ______________________________________________________________
WHY DID YOU DECIDE TO BY THE PRODUCT FROM THIS RETAILER: ___________________________
____________________________________________________________________________________________
COMMENTS: