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Commercial
CUSTOMER BONDING FORM
fields with * are mandatory
Name
*
:
Equipment looking for
*
:
select the equipment
Treadmill
Elliptical
Cycle
Rower
Stepper
Gym
Accessories
Others
None
Objective of buying the machine
*
:
Objective of buying
Weight Loss
Being Fit
Health Grounds
Muscle Tonning
Others
How many people will be using the machine
*
:
Men
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Women
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Users age
*
:
select the age
10-20 Years
20-30 Years
30-40 Years
40-50 Years
Above 50 Years
Maximum user weight / height
*
:
Maximum user weight
30-40
40-50
50-60
60-70
70-80
80-90
90-100
100-110
110-120
120-130
130-140
140-150
150-160
160-170
170-180
180-190
190-200
210-220
230-240
250-260
270-280
290-300
Maximum user height
3ft/91.5cm
3ft/106.5cm
4ft/122cm
4.5ft/137cm
5ft/152.5cm
5.5ft/167.5cm
6ft/183cm
6.5ft/198cm
7ft/213.5cm
7.5ft/228cm
Any pre-existing condition
*
:
select pre-existing condition
Heart
Diabetes
Hypertension
Knee Problems
Back Problems
Others
None
How did you know of ACME ?
*
:
-select-
Daily Ads
Magazine Ads
Hoardings
Existing Customer
Internet
Events
Referral
Others
What is your budget?
*
:
-select-
Rs.20,000 to Rs.40,000
Rs.40,000 to Rs.60,000
Rs.60,000 to Rs.80,000
Rs.80,000 to Rs.1,00,000
Above Rs.1,00,000
Contact details
*
:
Phone
*
:
Email
*
:
Would you like to be informed of any special offers / schemes from Acme Fitness?
*
:
Yes
No
Your Comments / Suggestions
:
