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Your Information
Mr.: Mrs.: Ms.: Miss.:  
*First Name:   *Last Name:
*Street Address:     Apt. No.:
*City:   *State/Province:
*ZIP/Postal Code:     Country:
  E-Mail:   *Date of   Purchase:
*Daytime Phone:    Evening Phone:
Purchased From



     Other: 
If purchased from other than CORSA Direct
Purchased From:   City:
Street Address:   ZIP/Postal Code:
State/Province:   Country:
Phone:      
Vehicle Application
Manufacturer Make:   Chassis:
Model:   Engine:
Year:      
 
What part number did you purchase?
 
Installation
Did you perform the installation yourself?
If "Yes", how would you rate the ease of installation?  
If "No ",  please tell us who did install it below:
*Name:   *City:
  Street Address:     ZIP/Postal Code:
  State/Province:     Country:
  Phone:      
Rate your experience with CORSA Performance
Technical Support:  Sales Assistance: 
 
Rate the Quality of your CORSA Product:  
 
How did you first learn of CORSA?



     Magazine Name:       Other: 
 
What features and/or factors might have influenced your purchase of a CORSA product?
(Check all that apply)





      Other: 
*U.S. Patent Numbers 5,952,625 / 6,199,658 / Other Patents Pending
How would you best describe the sound of your CORSA exhaust system?
Comments:
 
Do we have your permission to publish your comments and first name?
 
Your Vehicles and Interests
What other vehicles do you own?
Make:  Model:  Year:   
Make:  Model:  Year:   
Make:  Model:  Year:   
Make:  Model:  Year:   
 
Do you own a boat or motorcycle?
Boat Make:   Motorcycle Make:
Model:   Model:
Year:   Year:
What magazines do you read on a regular basis?
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Publication 3:   Publication 4:
 
What websites do you visit on a regular basis
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