Customer Feedback Survey Site Name/Customer ID (if you have one) Today's Date Month 1 2 3 4 5 6 7 8 9 10 11 12 Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Year 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 Overall, how satisfied are you with your recent experience? Very Satisfied Satisfied Neutral Dissatisfied Very Dissatisfied Please explain your rating: What can we do differently to make this experience better? * Please rate your satisfaction with the following related to your recent experience: Very Satisfied Satisfied Neutral Dissatisfied Very Dissatisfied Responsiveness Purchasing Experience Installation Experience Follow Up Services Additional Comments Please provide us with additional information about your company’s experience: What products/services were provided? How often do you purchase from our company?.... 0-1 Times/Year 1-3 Times/Year 3-7 Times/Year 7-12 Times/Year 12+ Times/Year What is the main reason you use our company’s products and services? Would you purchase these products and services again from our company? Yes No Unsure Why or Why Not? Would you recommend us to another company? Yes No Unsure Why or Why Not? For future surveys, how would you prefer to be contacted? Phone Survey E-Mail Survey Online Survey Phone Number E-Mail Address *