10
Your answers to the following questions are appreciated.
Date Purchased
Model No.
Serial No.
Initial Last Name
Street Address
City
Province
AGE:
Male
Female
Married
Single
Month
Day
Year 20
Under 19
20-29
30-39
40-49
Over 50
Paste
Paste
Paste
Paste
Paste
Paste
Paste
Paste
P
aste
P
aste
P
aste
P
aste
P
aste
P
aste
P
aste
P
aste
P
aste
P
aste
P
aste
P
aste
1. This product was purchased from?
Industrial Supply
Other ( )
Tool Distributor
Hardware/lumber Store
2. Use of the product is intended for?
5. Any comments?
Home maintenance
Other ( )
Industrial maintenance
Construction trade
3. How did you first learn of Makita Power Tools?
Catalog
Other ( )
From dealer
Magazine/Newspaper
Store display
4. Most favored points are?
Makita Brand
Power
Features
Design
Other ( )
Size
Price
Occupation:
Dealer's Name & Address:
Postal Code
Certificate of Warranty
Mail to Makita
