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1. This product was purchased from:
Home Center
Hardware/Lumber Store
Tool Distributor
Industrial Supply
Construction Supply
Other ( )
3. How did you learn about this product:
Magazine
From Dealer
Newspaper
Store Display
Catalog
Radio
Exhibition
From Friend
Previous Usage
Other ( )
2. Use of the product is intended for:
Construction Trade
Industrial Maintenance
Home Maintenance
Hobby
Other ( )
4. Most favored points are:
Repair Service
Durability
Power
Other ( )
Design
Features
Size
Price
Makita Brand
5. Any comments:
MAIL THIS PORTION
Your answers to the following questions are appreciated.
BE SURE TO COMPLETE THE CUSTOMER
’
S PORTION OF THIS FORM AND RETAIN FOR YOUR RECORDS.
DATE PURCHASED
MODEL NO.
SERIAL NO.
INTL.
LAST NAME / COMPANY NAME
STREET ADRESS
CITY
STATE
AGE:
ZIP CODE
PHONE
AREA
CODE
STATUS
Married
SEX
M
F
Single
MONTH
DAY
YEAR
Under 19
20-29
30-39
40-49
50-60
Over 60
Please return this portion by facsimile or mail.
Facsimile No: (714) 522-8133
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