
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:
Home Center  | Other (  | )  | 
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 ()
Magazine
From Dealer
Newspaper
Store Display
Catalog
4. Most favored points are:
Design
Features
Size
Price
Makita Brand
Radio
Exhibition
From Friend
Previous Usage
Other ()
Repair Service
Durability
Power
Other ()
5. Any comments:
Paste Paste Paste Paste Paste Paste
DATE PURCHASED  | 
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MONTH  | DAY  | YEAR  | 
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  | SERIAL NO.  | 
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  | STATUS  | 
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INTL. LAST NAME / COMPANY NAME  | 
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  | Married Single  | M  | F  | |||||
STREET ADRESS
CITY
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STATE  | 
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  | PHONE  | 
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AGE:  | 
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  | Under 19  | 
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  | Over 60  | ||||||||||||
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BE SURE TO COMPLETE THE CUSTOMER’S PORTION OF THIS FORM AND RETAIN FOR YOUR RECORDS.
Please return this portion by facsimile or mail.
18Facsimile No: (714) 
Paste Paste Paste Paste Paste Paste
Paste  | Paste  | Paste  | Paste  | Paste  | Paste  | Paste  | Paste  | 
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