Midas Info Request
Name
Address
 
 
City
State/Provence
Country

Postal Code         Country
Home Phone         Work Phone
Fax         Email

Product Purchased
Serial Number
Dealer Purchased From
Purchase Date
Price
City
Country

How did you first hear about this product ?
Advertisment  Dealer 
Exhibition  Magazine 
Friend     
Other 

What influenced your decision to purchase a Midas product?
Quality Recommended
Features Reputation 
Price     
Other 

How often would you like to be updated on Midas products ?
Comments