The objectives of this research were (1) To study the influence of the after sales service quality which consisted of the dimensions of tangible reliability responsiveness assurance and empathy on customer trust; (2) To study the influence of the aftersales service quality and customer trust on customer satisfaction; (3) To study the influence of customer trust and satisfaction on customer loyalty and (4) To validate the causal relationship model of the influence of aftersales service quality on trust customer satisfaction and customer loyalty of medical’s equipment business with empirical data. The variables in this investigation consisted of the following; aftersales service quality which consisted of the dimensions of (1) tangible; (2) reliability; (3) responsiveness ;(4) assurance and (5) empathy as the independent variable; customer trust and satisfaction as mediating variables and customer loyalty as dependent variable.

Currently the pineapple leaf paper that is produced by using local wisdom is 50 centimeters wide and 64 centimeters long. Therefore the product of the Cooperative is small. And because the size of the paper is limited they cannot be used for producing room divider big umbrella or big painting as per customer’s demand and the members of the cooperative cannot produce large sheet of paper. The researchers therefore designed the Pineapple fibrous leaf sieving Equipment in order to produce large sheet of paper. The equipment consists of a square basin for washing leaf fiber sized 185 centimeters 10 centimeter deep with a 90-centimeter high stand to support the basin and installed the mechanism to lift up the sieve that is used to take up the pineapple leaf fiber. The sieve is 150 centimeters x 150 centimeters which is the largest size possible because the leaf fiber washing must is done by hand. If the sieve is bigger we will not be able to reach to the leaf fiber in the center. Base on the experiment of pineapple leaf paper production by using the new equipment as compared to the paper production as per local wisdom by using 2.5 kilograms pineapple leaf fiber and the paper thickness shall be fixed at 0.35 millimeters it is found that the production that use pineapple fibrous leaf sieving equipment takes 647 second on average and the production as per local wisdom takes 1421 second on average. In other words the equipment can help to reduce the time in paper production of 774 second or 54 %. Apart from that the researcher produced the paper with different thickness by increasing the pineapple leaf fiber by 0.5 kilograms per one sheet of paper so that there are more options to choose in order to match with various products. The amount of leaf fiber used in the production starts from 3 kilograms to 7.5 kilogram per sheet and the thickness of the paper is from 0.36 millimeters and the thickest paper is 1.2 millimeters thick using approximately 7.5 kilograms of leaf fiber. If we use more leaf fiber for paper production the paper will be overweight and it will be sagging.