Free Information Packet
Thank you for visiting our website. We hope you found it informative. We want to provide you all the information you need about the Power Pumper and therefore offer a Free Info Packet which includes a DVD presentation. Please fill in the information below and we will send you your packet right away.

Note:   This information is confidential and is to be used solely by Columbia Inland Corporation. It will not be sold or distributed to any other parties.
Please fill in the information below.
FIRST & LAST NAME: *
COMPANY NAME: *
STREET ADDRESS: *
City: *
State: *
ZIP: *
Day Phone: *
EMAIL ADDRESS: *
Your Position: *
OPTIONAL - PLEASE INDICATE THE ONE THAT IS MOST APPROPRIATE:
WHAT BEST DESCRIBES YOU:
OCCUPATIONAL THERAPIST
PHYSICAL THERAPIST
PARENT OF A CHILD IN THERAPY
OTHER
WOULD YOU SAY THAT YOU ARE:
VERY INTERESTED IN PURCHASING THE POWER PUMPER IN THE NEAR FUTURE
MODERATELY INTERESTED IN THE POWER PUMPER FOR SOMETIME IN THE FUTURE
JUST BEGINNING TO LOOK INTO IT
OTHER
ARE YOU INTERESTED IN THE:
POWER PUMPER FOR CHILDREN 5 - 11 YEARS OF AGE
POWER PUMPER JR. FOR CHILDREN 3 - 5 YEARS OF AGE
BOTH
WHAT ATTRACTS YOU MOST ABOUT THE POWER PUMPER?:
IT BENEFITS BOTH UPPER AND LOWER EXTREMITIES
HAVING A DEVICE THAT WILL MOTIVATE CHILDREN TO DO THEIR THERAPY
IT LOOKS LIKE A FUN, HEALTHY ACTIVITY THAT WILL MOTIVATE CHILDREN TO EXERCISE
Other
HOW DID YOU FIND OUT ABOUT THE POWER PUMPER?:
THROUGH OTHER THERAPISTS OR EDUCATORS
MAGAZINE AD
INTERNET SEARCH
CONVENTION OR TRADESHOW
Other
DID YOU FIND THE INFORMATION ON THIS WEBSITE TO BE:
VERY HELPFUL
SOMEWHAT HELPFUL
NOT HELPFUL
Columbia-Inland Corporation
606 15th Street
Oregon City, OR 97045
Phone:
Toll Free:
Fax:
E-mail: 		503.657.6676
888.215.7867
503.722.2962
info@powerpumper.com