Customer Company Name:

Contact Person:

Date:

Telephone:

Please answer the following questions to the best of your ability.

Please rate us as follows: 1-Unacceptable 2-Needs Improvement 3-Average 4-Satisfied 5-Very Satisfied

1. Please rate your overall satisfaction with our company:
5 4 3 2 1

2. The quality and/or services provided:
5 4 3 2 1

3. The knowledge of your requirement:
5 4 3 2 1

4. Our ability to meet your needs:
5 4 3 2 1

5. When contacting our company by phone, fax or e-mail, how would you rate our response:
5 4 3 2 1

6. How would you rate our customer service:
5 4 3 2 1

7. What have you liked the most about dealing with our company:

8. If you were not satisfied with any of the areas mentioned above, please explain in detail:

9. What improvements could we make to serve you better: