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First name
Last name
Address
City
State/Province/Locality
Country
Postal Code
Date Purchased
Month:
1
2
3
4
5
6
7
8
9
10
11
12
Day:
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Year:
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
Model Number
Serial Number
Email Address
Dealer Purchased From
Type of Boat :
Power
Sail
Commercial
Size of Boat:
Feet
Meters
Next Purchase:
GPS/Chart Plotter
VHF Handheld Radio
VHF Fixed Mount Radio
Fishfinder
Stereo CD Player
Depth Sounder
Autopilot
Other
When?
Select when Next purchase is planned
0 - 1 week
1 - 2 week
2 week - 1 month
1 - 3 months
more than 3 months
Unknown
How did you hear about Standard Horizon?
Dealer
Friend
Direct Mail
Previous Purchase
Magazine/Print (Which one
)
Internet (How?
)
Other (
)
COPYRIGHT©2003-2013 Yaesu USA
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