Name:
Address:
E-mail.:
a b c d e
Through a friend Through News Through Hoarding Recommended by Any other Source
Paper, Technician
Advertisement
a b c d e f g
Service Line Plumbing Line Rain Water Bore Well Riser Distribution Any Other
Connection Line Casing Pipes Line For
Irrigation
Upvc pipes Cpvc Pipes Garden Bore well HDPE Pipe SWR Pipe Agri Pipes Water Tank
& Fittings & Fittings Hose Pipes & fittings & Fittings & Fittings
a b c d
Excellent Good Fair Poor
Contd.P/2.
Page.2
07. How do you like Price.:
a b c d
Cheaper Fair Reasonable Costly
a b c d
Very Good Good Fair Poor
a b c d
Very Good Good Fair Poor
a b
Yes No
If the answer is Yes, then the type of assistance may please be indicated.
11. Have you referred to others to purchase ORI-PLAST products if you had used earlier?
a b
Yes No
I) About Product:
.
II) About Distributors/Dealers:.
.
III) Any Other:
THANK YOU VERY MUCH FOR SPARING YOUR VALUABLE TIME FOR US.
DATE: .
PLACE: SIGNATURE