*1. Native Language: Choose English French
*2. First Name:
Initial:
*Last Name:
*Address:
Apt Number:
*City:
*Province: Choose Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon
*Postal Code:
*3. Phone
*4. Email Address: (Example: yourname@yourhost.com)
Yes! I want to receive offers or communications from Hitachi via e-mail.
*5. Date of Purchase:   January February March April May June July August September October November December     01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31     2005 2006 2007 2008 2009 2010
*6. Model Number:
*7. Serial Number:
8. What is the type of intended use/application for this tool? Choose Do-it-yourselfer Hobbyist Home improvement Professional Woodworking
9. What do you plan on purchasing next? Choose A. Corded Drill/Driver (A) Reciprocating Saw (A) Circular Saw (A) Miter Saw (A) Hammer Saw (A) Hammer Drill (A) Sander (A) Porta-Band (A) Right-Angle Drill (A) Impact Wrench (A) Rotary Hammer (A) Nail gun/Stapler (A) Router (A) Vacuum (A) Jig Saw (A) Other Corded Product B. Cordless Drill/Driver (B) Reciprocating Saw (B) Circular Saw (B) Combo Kits (B) Impact Wrench (B) Hammer Drill (B) Rotary Hammer (B) Right Angle Drill (B) Screw Driver (B) Other Cordless Product
10. Please select the option that best describes your ocupation Choose Residential building Remodeling/home improvement Commercial Construction Plumbing HVAC Electrical Masonry-brick/concrete Plaster/drywall installation Tile/marble/flooring Cabinet/furniture carpentry Roofing/siding/steel Other woodworking Industrial/maintenance/manufacturing Agriculture/farm use Government Automotive/boating Other commercial construction Other non-trade
11. Where do you usually purchase your Hitachi tools? Choose Contractor supply Home center Electrical supply Tool supply Lumber/building supply Woodworker supply Industrial supply Hardware store Plumbing supply Welding supply Rental Internet Mail order Don't know Received as a gift Other
12. How many power tools do you own/use? Choose 1-3 4-6 7-10 11-15 16-24 25+
13. Please select two (2) of the following reasons that most influenced the purchase of this Hitachi tool. Reputation Tool Capability Tool Reliability Feel of Comfort Durability of the Tool Availability of the product Service of Product Price
14a. If replacing an electric tool, which brand? Choose Makita Black & Decker/DeWalt Milwaukee Skil/Bosch Ryobi Porter Cable Other
14b. If replacing a pneumatic tool, which brand? Choose Senco DeWalt ITW Paslode Stanley-Bostich Porter Cable Max Other
15. If you are a commercial/trade user, what is your purchase authority? (Select all that apply) Specify Tools Purchase Tools Tool User
16. What percentage of the power tools you own are Hitachi tools? Choose 1-10% 11-25% 26-50% 51-75% 76-99% 100% First time purchase of Hitachi brand
17. Your gender: Choose Male Female
18. Your marital status: Choose Married Single
19. Date of your birth:   January February March April May June July August September October November December     01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31     1900 1901 1902 1903 1904 1905 1906 1907 1908 1909 1910 1911 1912 1913 1914 1915 1916 1917 1918 1919 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000
20. Including yourself, what is the total number of people living in your household?
21. For your primary residence, do you: Choose Own Rent
22. Which best describes your family income? Choose Under $15,000 $15,000 - $24,999 $25,000 - $34,999 $35,000 - $49,999 $50,000 - $74,999 $75,000 - $99,999 $100,000 - $124,999 $125,000 - $149,999 $150,000 - $174,999 $175,000 - $199,999 $200,000 - $249,999 $250,000 or over
23. Education: Choose Some high school Completed high school College degree Undergraduate degree Graduate degree
	* denotes required field