MAIL THIS PORTION
Your answers to the following questions are appreciated.
| 1) This product was purchased from: | 3) How did you learn about this product: |
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| Home Center |
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| Magazine |
| Radio |
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| Hardware/Lumber Store |
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| Dealer |
| Exhibition |
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| Tool Distributor |
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| Newspaper |
| From Friend |
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| Industrial Supply |
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| Store Display |
| Previous Usage |
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| Construction Supply |
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| Catalogue |
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| Other |
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| Other |
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| 2) Use of this product is intended for: | 4) Most favored points are: |
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| Construction Trade |
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| Design |
| Repair Service |
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| Industrial Maintenance |
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| Features |
| Durability |
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| Home Maintenance |
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| Size |
| Power |
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| Hobby |
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| Price |
| Makita Brand |
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| Other |
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| Other |
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| 5) Any comments: |
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| DATE PURCHASED |
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| SERIAL NO. |
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| INTL. LAST NAME / COMPANY NAME |
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| STATUS | SEX | ||||||||||
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| Married | Single | Male Female | ||||||||||
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ADDRESS:
CITY: |
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ZIP / POSTAL CODE: |
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| COUNTRY: |
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| AREA CODE: |
| TELEPHONE: |
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AGE: 
Under 19 
20 - 29 
30 - 39 
40 - 49 
50 - 59 
Over 60
BE SURE TO COMPLETE THE CUSTOMER’S PORTION OF THIS FORM AND RETAIN FOR YOUR RECORDS
Please return this portion by facsimile or mail ... Facsimile Number (714)