Warranty Registration

*Required Fields
Person Completing this form:
First Name: *
Last Name: *
Title: *
Are you responsible for recommending, specifying and/or purchasing equipment and services? *
Yes No
If you answered NO to the previous question please specify who is responsible for those activities.
First Name:
Last Name:
Title:
 
Company: *
Address: *
City: *
State/Province: *
Zip/Postal Code: *
Country: *
Business Phone: *
Business Fax:
E-Mail Address: *
Invoice/Sales Order Number *
Machine Model Number: *
Serial Number: *
To help us serve you better, please take a moment to rate our performance concerning your purchase. Please indicate your response on a scale of 1-5, 5 being the most favorable or most likely and 1 being the least favorable or least likely.(
*All Questions
Require a Rating
1 2 3 4 5
1.) It was easy to place my order.
2.) My order was delivered on time.
3.) The tool arrived without damage.
4.) The tool met my expectations.
5.) My order was shipped complete.
6.) I am likely to purchase more Wachs equipment.
7.) I am likely to refer associates to Wachs.
8.) I would like to receive product updates for my Wachs equipment? YES    NO
9.) I was contacted by a Wachs representative after I received my order.
Method:
 Face-to-face   Phone   Email   Fax   Was not contacted
Other
Comments: