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For your protection, please complete the following form. By doing so, your
product will be officially registered with Powr-Flite. This information will help
provide better products and services to meet your needs.



Model Number:
Serial Number:
Date of Purchase:
Purchased From:


Company:
Name:
Job Title:
Address:
City:
State:
Zip:
Phone:
Fax:
Email:




1.Type of business (check one)
Building Contractor Car Wash Manufacturing
Carpet Cleaner Church Restoration
Day Care Education Rental Store
Government Health Care Other
Hospitality Janitorial Service


2. How did you learn of Powr-Flite? (check one)
Business Associate Sales Representative Website
Direct Mail Distributor Other
Magazine Ad Tradeshow


3. Please indicate the condition of the equipment when receivedwhen order was received. (check one)
Very Good Good Unsatisfactory


4. Please indicate the condition of the packaging when received when order was received.(check one)
Very Good Good Unsatisfactory


5. How did you receive training? (check one)
Distributor Seminar Video Other


6. Did you receive training on your equipment? (check one)   Yes   No


7. Have you purchase Powr-Flite chemicals? (check one)   Yes   No


8. Do you own or use other Powr-Flite equipment? (check one)
   Yes   No


9. Please check the 3 top reasons that influenced your decision to purchase this product.
Accessories Available Availability Warranty
Ease of Use Features Service
Cleaning time Cleaning ability Value
Price Dry time Other
Reliability Quality


10. Which of the following do you intend to purchase within the next 12 months? (check all that apply).
Air Mover (Dryer) Auto Scrubber Vacuum (canister)
Burnisher Extractor Vacuum (wide area)
Chemicals (carpet) Chemicals (hard floor) Vacuum (upright)
Floor Machine Sander Wet/Dry Vacuum
Sweeper Vacuum (backpack) Other



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