Name:
Address:
City:
State:
Zip Code:
Phone Number:
Email Address:
What boat do you currently own?
What model of boat are you looking for?	100 Series 600 Fisherman Series Saltwater Series Z Series Reata Series Angler Series
Specific Model:
What brand of outboard interests you?	Yamaha Evinrude Mercury Suzuki
When is your preferred time to purchase a boat?	1 Month 3 Month 6 Months 1 Year
Would you like a Ranger Catalog?	Yes No
Contact Location: (tournament, event, parking lot, boat ramp, etc.)
Do you have a dealer preference?
Angler Name:
Date of Referral Contact:

© Liddle Marketing Company  |  P.O. Box 114 • Victoria, MN 55386  |  George Liddle 612-961-4734  |