First name
Last name
Address
City
State/Province/Locality
Country
Postal Code
Date Purchased
Month:
1
2
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5
6
7
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9
10
11
12
Day:
1
2
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4
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Year:
1995
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2014
2015
2016
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2019
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2021
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2024
Model Number
Serial Number
Email Address
Dealer Purchased From
How was this product purchased?
In Store
Hamfest (Specify
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Mail Order
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Why did you purchase this product?
Price
Design
Brand Name
Reputation
Features (Specify
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Influences to purchase this product?
Recommendation from another ham
Advertising
Magazine Product Review
Salesperson
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Amateur Radio Magazines you read?
QST
Popular Communications
CQ
Monitoring Times
73
Worldradio
Spanish CQ
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