I am registering an instrument that is:
New Used

First Name:
Last Name:
Address:
City:
State:
Zip Code:
Country:
Day phone:
Eve Phone:
Serial number:
Date Purchased:
Dealer:	(if used, previous owner)

Comments

1. Reason for selcting this instrument? Quality Price Trust in Alembic
Other, please explain

2. Pleased with purchase? Yes No
Should any point be improved?

3. Do you plan to purchase another Alembic? Yes No Perhaps
When?