Customer Survey

First Name*

Last Name*

Company

Address

City

State/Province

Postal Code

Country

Phone*

Fax

Email*

Select One Analyzers Analyzer Bracket/Mount Blender – High Flow Blender – Low Flow Blender Bracket/Mount Coiled Hose Disposable Oxygen Dome Pulse Oximeter Phototherapy Mask Sensors SpO2 Probe SpO2 Cable Ventilator Ventilator Test Lung Other Type of product ordered?

Product Name*

Product Part Number

Why did you choose a Maxtec product? (check all that apply)

Price (Cost of ownership/overall value)

Quality

Customer Service

Long Warranty

Advanced Technology

Ergonomic Aspects

One-Stop Shopping

Sales Rep

Other

Would you buy a Maxtec product again?

Yes

No

Undecided

Please rate the following: (1=very unsatisfied, 6=very satisfied)

Are there any products that Maxtec does not currently sell that you would like to see us provide in the near future?

Tell us about anything Maxtec can do to make you a happier customer: