* 1. First Name:

* 2. Last Name:

* 3. Phone Number:

* 4. Email:

* 5. Mailing Address:

* 6. Delivery Date:

Date machine was delivered

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

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

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

* 10. CEC Location:

* 12. How did you hear about us?

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

* 14. Additional Comments:

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