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MAIL THIS PORTION
Your answers to the following questions are appreciated.
1. This product was purchased from:
Home Center
Hardware/Lumber Store
Tool Distributor
Industrial Supply
Construction Supply
2. Use of the product is intended for:
Construction Trade
Industrial Maintenance
Home Maintenance
Hobby
Other (
)
5. Any comments:
DATE PURCHASED
MONTH
DAY
INTL.
LAST NAME / COMPANY NAME
STREET ADRESS
CITY
STATE
AGE:
Under 19
BE SURE TO COMPLETE THE CUSTOMER'S PORTION OF THIS FORM AND RETAIN FOR YOUR RECORDS.
Please return this portion by facsimile or mail.
18
Facsimile No: (714) 522-8133
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3. How did you learn about this product:
Other (
)
4. Most favored points are:
MODEL NO.
YEAR
SERIAL NO.
ZIP CODE
20-29
30-39
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Magazine
From Dealer
Newspaper
Store Display
Catalog
Design
Features
Size
Price
Makita Brand
Married
AREA
CODE
PHONE
40-49
50-60
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Radio
Exhibition
From Friend
Previous Usage
Other (
)
Repair Service
Durability
Power
Other (
)
STATUS
SEX
M
F
Single
Over 60
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