Warranty Form
* First Name:
* Last Name:
Company:
* Address 1:
Address 2:
* City:
* State/Province:
* Zip:
* Country
* E-mail:
* Phone:
Fax:
If Other, please list
* Serial Number:
(Other Serial Number)
1. Where did you purchase this product? *
2. What other Midtronics products do you own? *
3. Your title:
4. Type of business:
5. Specify types of batteries you use or supply:
6. Type of batteries you sell:
7. Specify where you heard about Midtronics:
8. Which magazine or distributor did you hear about us from?
9. How does the Midtronics tester/ monitor meets your expectations?
10. Did you purchase from Midtronics directly?
 Yes - please go to question 11
 No - please go to question 13
11. If yes (from #10) how would you rate the service you received from our Customer Service Department?
 Excellent
 Good
 Satisfactory
 Below average
 Poor
12. Were your questions/concerns handled effectively?
 Yes
 No
13. Please share your comments about our service here, including your thoughts on Midtronics products and service.
14. Is there any other tool you need that no one else provides?
15. Please enter any additional comments here.
16. May we have permission to reprint your comments?
 Yes
 No