subject_line
Customer Feedback
What is your relationship to Pana-Pacific?
*
Dealer Customer
End User Customer
Supplier
Employee
Submitted By:
*
Department
*
When was your last contact with a Pana-Pacific sales representative?
*
Last 30 Days
Last 3 Months
Last 6 Months
Last 12 Months
Never
Other
If Other, please note below:
*
What state are you located in?
*
---UNITED STATES---
AL
AK
AZ
AR
AS
CA
CO
CT
DE
DC
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
--CANADA--
AB
BC
MB
NB
NL
NT
NS
NU
ON
PE
QC
SK
YT
Who is your sales rep?
*
Dennis Wilson
Bryan Mansell
Larry Lienhard
Erin McNulty
Tim Gilbert
Don Wimberly
Darren Friesen
Michael Cowen
Unknown / Other
Powered by