40
CERTIFICATE OF GUARANTEE /CUSTOMER SATISFACTION ENQUIRY
– P4 Crossover
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 CROSSOVER Off-Road Electric Wheelchair, and we thank you for your trust in
our products. We would appreciate your remarks or suggestions as a P4 CROSSOVER 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 assessment :
With the dealer
With our salesperson
Both
Neither