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Please take a couple of minutes to fill out your registration card. This informal
survey will aid us in providing our customers with the best possible product.
Name: ______________________________ Address: _____________________________________
City:_______________________________ State:______ Country:____________ Zip:____________
Phone: (Home)_______________________________ (Work)________________________________
Purchase Date: ________________ Purchased From: _____________________________________
Serial Number (Stamped on ZAPPY motor guard. Flip ZAPPY over to read serial number):
_________________________________________________________________________________
Age:______ Sex:______ Occupation:__________________________________________________
Is this your first Electric Vehicle?_______________________________________________________
I use my ZAPPY for: Commuting Recreation Work Fun Shopping Exercise Environment
If work, what application_________________________________________
Other_________________________________________ My typical length of ride is: ________miles
Where did you hear about our product? Friend Relative Associate Internet Show News Article Dealer
Ad (where)______________________________ Other_____________________________________
Are you interested in ZAP Shareholder information? (Our stock symbol NASDAQ:ZAPP)
Yes No
Do you use the internet?
Yes No If so, what is your E-mail address? ___________________________________
Favorite Magazines:
1. ________________________ 2. ________________________ 3. ________________________
Favorite TV Shows:
1. ________________________ 2. ________________________ 3. ________________________
Are you interested in a ZAP Store? Are you interested in selling ZAPs?
Yes No Yes No
Are you interested in assisting us in: (check applicable)
Marketing _______ Public Relations _______
Dealer Information _______ A ZAP Franchise _______
Comments:________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
WARRANTY CARD: Please complete both sides and return within 10 days of purchase.
THANK YOU!
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ZAPWORLD.COM
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