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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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