* Indicates a required field

1. Contact Information

Title

MrMrsMsMiss

*First Name:	*Last Name:

*Street/PO Box/Address:	Apt/Bldg/Suite:
*City/Town/Region	*State/Province/Territory
*Zip/Postal Code	*Country/Region
*Phone:(xxx)xxx-xxxx	Fax:(xxx)xxx-xxxx
*E-mail

2. Your date of birth:MonthJanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecemberYear20092008200720062005200420032002200120001999199819971996199519941993199219911990198919881987198619851984198319821981198019791978197719761975197419731972197119701969196819671966196519641963196219611960195919581957195619551954195319521951195019491948194719461945194419431942194119401939193819371936193519341933193219311930192919281927192619251924192319221921192019191918191719161915191419131912191119101909190819071906190519041903190219011900

3. Marital Status MarriedSingle

4. Product Information:*  Model #

*Serial #

5. Date of Purchase MonthJanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecemberDay01020304050607080910111213141516171819202122232425262728293031Year201320122011201020092008200720062006

6. Name of store where purchased:

7. What will this product primarily be used for? Business plant/shopAutomotiveJobsite/constructionWoodworkingEquipment maintenanceHome improvementCamping/boating/RVInflationOther

8. How often will you use this product? Daily - 5 times or more per dayFrequently - at least once per weekOccasionally - at least once per monthInfrequently - less than one time per month

9. Which factors and features most influenced your decision to purchase this product?(Check up to 3)

Ease of operation		Warranty		Product packaging
Made in USA		Brand reputation		Salesperson recomm.
Price		Availability of accessories		Catalog/web/advertising
Overall appearance/feel		Friend/relative		Quality/durability
Prior experience		Other

10. Which choice best describes yourself?

Select I use powered equipment and tools in my everyday occupationI use powered equipment and tools occasionally to make extra moneyI use powered equipment and tools frequently for do-it-yourself projectsI use powered equipment and tools occasionally for do-it-yourself projects

11. Occupation/employment status:(Check all that apply)

	You	Spouse		You	Spouse
Professional/technical			Health care/physician/nurse
Upper management/executive			Homemaker
Middle management			Military
Sales/marketing			Retired
Clerical/service worker			Self employed/business owner
Tradesmen/machine op/laborer			Work from home office
Teacher/educator