Olympus

If you have already filled out and mailed your microscope registration card you do not need to use this form. The optional questionnaire that follows will help us to continually improve our Olympus microscopes, and we appreciate your feedback. If you are registering multiple microscopes, please fill out the entire form first and click submit. You will then be prompted to register the model and serial number for each additional microscope.

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Mr. Mrs. Ms. Dr.
* First Name:	M. Initial:	* Last Name:
Company:		Title:
* Address: (Number and Street)		Address 2:
* City:		* State: [select state] AL-Alabama AK-Alaska AZ-Arizona AR-Arkansas CA-California CO-Colorado CT-Connecticut DC-Washington D.C. DE-Delaware FL-Florida GA-Georgia HI-Hawaii ID-Idaho IL-Illinois IN-Indiana IA-Iowa KS-Kansas KY-Kentucky LA-Louisiana ME-Maine MD-Maryland MA-Massachusetts MI-Michigan MN-Minnesota MS-Mississippi MO-Missouri MT-Montana NE-Nebraska NV-Nevada NH-New Hampshire NJ-New Jersey NM-New Mexico NY-New York NC-North Carolina ND-North Dakota OH-Ohio OK-Oklahoma OR-Oregon PA-Pennsylvania PR-Puerto Rico RI-Rhode Island SC-South Carolina SD-South Dakota TN-Tennessee TX-Texas UT-Utah VT-Vermont VA-Virginia WA-Washington WV-West Virginia WI-Wisconsin WY-Wyoming	* Zip:
Phone Number: ( ) - -		Fax Number: ( ) - -
* Email Address:		* Re-enter Email Address:

* Model Number:	* Serial Number:	* Date of Purchase: (ex: March/25/2000) [Month] January February March April May June July August September October November December / [Day] 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 /
* Olympus Dealer or Sales Representative product was purchased from:

1. How many microscopes do you have in your lab?       Please check one: (0 = first time buyers) 0     1-5     6-10     11-19     20+
2. Who is the primary manufacturer of your microscopes? Olympus     Other     Other
3. What is your current satisfaction level with your primary manufacturer?       (Rating scale of 1-10 with 10 being the highest.)
4. When you purchased your Olympus system, what was your satisfaction level with the Olympus Dealer/Sales Rep?   (Rating scale of 1-10 with 10 being highest.)
Comments:
5. How satisfied were you with the installation support?       (Rating scale of 1-10 with 10 being highest.)
Comments:
6. It is important for us to provide products of the highest quality both in terms of performance and reliability. How would you rate the quality of Olympus microscopes?    (Rate from 1-10 with 10 being very satisfied.)
Comments:
7. Which of the following trade publications to you read regularly?       (Please check all that apply): ASC Bulletin Journal of Cell Biology Advance for Administrators Journal of Neuroscience American Biotech Lab Lab Equipment American Lab Microscopy & Analysis Biomedical Products Modern Drug Discovery Biophotonics Intl Nature Biophysical Journal R&D Biotechniques Science CAP Today The Scientist Clinical Lab Products Other (Please Specify) Drug Discovery

8. How often do you log onto the Internet?
Daily	Weekly	Monthly	Rarely/Never
9. What is your main reason for using the Internet?
Research	New Product      Information	Personal	Other
10. What is your primary application? Please check one:
Clinical	Industrial	Research	Other

11. If you have ever requested service or maintenance of your existing Olympus microscope(s), please rate your overall satisfaction of the way your request was handled by Olympus and/or the authorized Olympus Service Center? (Rate from 1-10 with 10 being very satisfied)
Comments: