First Name:

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* 1. First Name:

Last Name:

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* 2. Last Name:

Phone Number:

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* 3. Phone Number:

Email:

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* 4. Email:

Mailing Address:

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* 5. Mailing Address:

Delivery Date:

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* 6. Delivery Date:

Date machine was delivered
Did you receive your Operator's Manual?

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* 7. Did you receive your Operator's Manual?

Are you satisfied with the Set-Up and Delivery of this equipment?

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* 8. Are you satisfied with the Set-Up and Delivery of this equipment?

Overall, how would you rate your satisfaction with our dealership for this purchase?

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* 9. Overall, how would you rate your satisfaction with our dealership for this purchase?

CEC Location:

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* 10. CEC Location:

Salesperson's Name:

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* 11. Salesperson's Name:

How did you hear about us?

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* 12. How did you hear about us?

Please check all items you'd like to learn more about:

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* 13. Please check all items you'd like to learn more about:

Additional Comments:

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* 14. Additional Comments:

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