Personal Information


Full Name
Address
City
Province
Postal Code



Email
Phone #
Gender
Age

ex: 123-456-7890
Male     Female
Under 20
20-29
30-39
40-49
50+
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Bicycle and Store Information


Store Name
Date of Purchase
Model
Serial Number

Any other comments:





How was your experience at the Giant Bicycle Dealer?
    Excellent - This place is amazing!
    Great
    Good
    OK
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How do you like your new bicycle?
    Excellent - Best bike ever!
    Great
    Good
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    Poor

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