Makita HR5000 Owners Manual - Page 14

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 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: Design Features Size Price Makita Brand Repair Service Durability Power Other ( ) 5. Any comments: Paste Paste Paste Paste Paste Paste Paste Paste DATE PURCHASED MONTH DAY YEAR MODEL NO. SERIAL NO. INTL. LAST NAME / COMPANY NAME STREET ADRESS CITY STATE ZIP CODE PHONE STATUS Married Single SEX MF AREA CODE AGE: Under 19 20-29 30-39 40-49 50-60 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. 14 Facsimile No: (714) 522-8133 Paste Paste Paste Paste Paste Paste Paste Paste Paste Paste Paste Paste