Warranty Registrations

Name of User: *

Name of Purchaser: *

E-Mail: *

Company/Institution: *

Department:

Address: *

City: *

State: *

Zip Code: *

Country: *

Phone: *

Fax:

Part Number: *

Date of Purchase: *

Serial Number: *

Company purchased from: *

Optional Information

How did you learn of this product?:

Advertisement
Reply/Bingo Card
Trade Show
Seminar
Colleague/Associate
Internet

Or other:

What applications/instrument is this product intended for?:

GC w/FID
FT-IR
T.O.C.
NMR
AA
Autosampler
Laser
THA
CO2 Analyzer
Mask Aligner
Thermal Analyzer
Stack Gas Sampler
Ozone Analyzer
Ozone Generator
Emission Analyzer
Solvent Evaporation
LC/MS
ICP

Or other:

How many of these instruments will be connected to this product?:

1 - 2
3 - 5
6 and up

What factor(s) most influenced your decision to purchase this product?:

Attractive Payback
Free-up lab floor space
Immediate delivery
Brand name/reputation
Compact size
Price
Ease of installation
Ease of operation
Recommendation/demonstration of salesperson
Reommendation of colleague or other
Eliminate inconvenience of cylinder gas
Dissatisfied with quality/consistency of cylinder gas/dewars

Which of the following purchase situations best applues to your acquiring this product?:

Replacement - old product, similar in function
Replacement - cylinders/dewars
New installation

Or other:

What other brand(s) did you consider before purchasing this product:

How are we doing?

Delivery of product on time?:

Excellent
Very Good
Satisfactory
Needs Improvement
Unsatisfactory

Product appearance/quality?:

Excellent
Very Good
Satisfactory
Needs Improvement
Unsatisfactory

Easy to install?:

Excellent
Very Good
Satisfactory
Needs Improvement
Unsatisfactory

Overall satisfaction?:

Excellent
Very Good
Satisfactory
Needs Improvement
Unsatisfactory

Would you recommend Parker Balston products to other individuals and associates?:

Excellent
Very Good
Satisfactory
Needs Improvement
Unsatisfactory

Comments, suggestions and new product ideas

Comments:


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