» Company: 

» Contact: 

» Title: 

» Street Address: 

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» Phone Number: 

Fax Number: 

» E-mail Address: 

» Purchase Date: 

» CoolCube 10 Serial No: 

» Dealer Name: 

» Dealer Location: 

» What is your type 
of business? 

» How did you hear 
about CoolCube 10? 

» What factor(s) 
most influenced 
your decision 
to purchase a 
CoolCube 10? 

» Have you 
previously purchased 
a CoolCube 10 unit? 

» Where is the unit used? 

» What is the primary 
use for this unit? 

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