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1.This product was purchased from:
Home Center
Hardware/Lumber Store
ToolDistributor
Industrial Supply
Construction Supply
Other ( )
3. How did you learn of 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 answer to the following questions are appreciated.
BE SURETO COMPLETETHE CUSTOMER’S PORTION OFTHIS FORM AND RETAINFORYOUR RECORDS.
DATE PURCHASED MODEL NO.
SERIAL NO.
INTL. LAST NAME / COMPANYNAME
STREET ADRESS
CITY
S TATE
AGE:
ZIP CODE PHONE
AREA
CODE
STATUS
Married
SEX
MF
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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