Customer Survey Form
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Contact Information
First Name *
Last Name *
Address
City
State/Province
Alabama, USA
Alaska, USA
Alberta, Canada
Arizona, USA
Arkansas, USA
British Columbia, Canada
California, USA
Colorado, USA
Connecticut, USA
Delaware, USA
District of Columbia, USA
Florida, USA
Georgia, USA
Hawaii, USA
Idaho, USA
Illinois, USA
Indiana, USA
Iowa, USA
Kansas, USA
Kentucky, USA
Louisiana, USA
Maine, USA
Manitoba, Canada
Maryland, USA
Massachusetts, USA
Michigan, USA
Minnesota, USA
Mississippi, USA
Missouri, USA
Montana, USA
Nebraska, USA
Nevada, USA
New Brunswick, Canada
New Hampshire, USA
New Jersey, USA
New Mexico, USA
New York, USA
Newfoundland, Canada
North Carolina, USA
North Dakota, USA
Northwest Territories, Canada
Nova Scotia, Canada
Ohio, USA
Oklahoma, USA
Ontario, Canada
Oregon, USA
Pennsylvania, USA
Prince Edward Island, Canada
Puerto Rico, USA
Quebec, Canada
Rhode Island, USA
Saskatchewan, Canada
South Carolina, USA
South Dakota, USA
Tennessee, USA
Texas, USA
Utah, USA
Vermont, USA
Virginia, USA
Washington, USA
West Virginia, USA
Wisconsin, USA
Wyoming, USA
Yukon Territory, Canada
Zip/Postal Code
Phone
Email
Questionnaire
Location Visited:
1) How would you describe your visit to our facility?
Excellent
Good
Fair
Poor
2) Were you satisfied with the service received?
Yes
No
3) Was our staff friendly, efficient and knowledgeable?
Yes
No
4) Was the time estimate given for your work request accurate?
Yes
No
5) If additional work was necessary, were you consulted first?
Yes
No
6) Did you find our facility to be neat and clean?
Yes
No
7) Have you visited our facility in the past?
Yes
No
8) Would you visit our facility again in the future?
Yes
No
9) What is your main reason for
visiting our Website?
Specials
Product Research/Purchase
Contact Info
Other, I visited the website for:
10) What would you change about our facility?
11) Other comments/suggestions: