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Your answers to the following questions are appreciated.
1. This product was purchased from:
3. How did you learn about this product:
Home Center
Magazine
Other ( )
Radio
Hardware/Lumber Store
From Dealer
Exhibition
Tool Distributor
Newspaper
From Friend
Industrial Supply
Store Display
Previous Usage
Construction Supply
Catalog
Other ( )
2. Use of the product is intended for:
4. Most favored points are:
Construction Trade
Repair Service
Design
Industrial Maintenance
Durability
Features
Home Maintenance
Power
Size
Hobby
Other ( )
Price
Other ( )
Makita Brand
5. Any comments:
DATE PURCHASED
MODEL NO.
MONTH
DAY
YEAR
SERIAL NO.
STATUS
Married
SEX
M
F
Single
INTL.
LAST NAME / COMPANY NAME
STREET ADRESS
CITY
AREA
CODE
STATE
ZIP CODE
PHONE
Under 19
20-29
30-39
40-49
50-60
Over 60
AGE:
BE SURE TO COMPLETE THE CUSTOMER’S PORTION OF THIS FORM AND RETAIN FOR YOUR RECORDS.
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Please return this portion by facsimile or mail.
14
Facsimile No: (714) 522-8133
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