Bud's Bangsticks Feedback Form
Please fill out the following form.
Any information used in completing this form is
under the protection of the "Right to Privacy Act."
We appreciate the courtesy you have extended to us by filling out our survey form. This form is instrumental in the maintenance and further development of our WebSite and to improve and enhance the service to our customers. The Information supplied in this form will remain confidential and will be used only to update our database and will not be given out to any other party or parties (This means NO MAILING LISTS). Bottom line: IT DOES NOT LEAVE OUR DATABASE.

Name:
Address:
City,State,Zip:
Home Phone:
Work Phone:
Cell phone:
Fax Machine:
Email:
Are you a diver? Yes No
Are you a boat captain? Yes No
Are you a "gator" harvester? Yes No
Are you a marine retailer? Yes No
If yes, what type?
If Other Business:
This equipment will be used for:
If Other Uses:
Please add a few comments, if you wish.