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Customer Information

















Farm location if different than home address

















Rigid/Crossbar
ROPS w/ Canopy
Cab
Folding

Demographics


Yes No


Vegetable
Crop
Livestock
Fruit
Dairy
Organic
Other -









Dealer
Self Installation



Yes
No


Yes
No


Yes
No


ROPS kits come with seatbelts. After installation of ROPS on your tractor do you intend to wear your seatbelt:
Always
During dangerous work
Rarely
N/A


Always
During dangerous work
Rarely
N/A


Always
During dangerous work
Rarely
N/A


Safety - General
Rebate Money
Sun Protection
Safety for family/workers
Hilly Terrain
Had a scare - need to get it on
Required for operations
Other - please explain


Last one in fleet
My only tractor
Use this more
Family member uses this tractor
Worker/neighbor uses this tractor
Used on dangerous ground
Other - please explain


Magazine
Newspaper
Dealer
Veterinarian
Cooperative Extension
Friend/Family
Farm Bureau
Mechanic
Other