HITACHI Power Tools: Customer Service

1. Native Language:

2. First Name: Initial: Last Name:

Address: Apt number:

City: State/Province: Zip code/Postal code:

3. Phone:

4. Email Address: (Example: yourname@yourhost.com)

Yes! I want to receive offers or communications from Hitachi via e-mail.

Yes! I want to receive offers or communications that may interest me from other companies via email. I understand this e-mail address may be shared with and/or combined with information from other sources.

5. Date of Purchase: 6. Model Number:

7. Serial Number:

8. What is the type of intended use/application for this tool?

9. What do you plan on purchasing next?

10. Please select the option that best describes your occupation

11. Where do you usually purchase your Hitachi tools?

12. Please select two (2) of the following reasons that most influenced the purchase of this Hitachi tool. (Hold down the control key on your keyboard ("Ctrl" or "Control") and click the mouse to make a second selection.)

13. What percentage of the power tools you own are Hitachi tools?

14. Your gender:

15. Your marital status:

16. Age?

17. For your primary residence, do you:

18. Which best desctibes your family income?

19. Education:

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