Thank you for being a customer. We're committed to monitoring the quality of the services and products we provide, as part of an ongoing improvement process. We would appreciate your feedback on our performance. (All submissions are anonymous.)

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1. What is your overall satisfaction rating with our company?

What is your overall satisfaction rating with our company? Very Satisfied	Somewhat Satisfied	Neither Satisfied Nor Dissatisfied	Somewhat Dissatisfied	Very Dissatisfied
If dissatisfied, please explain.

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2. How do you rate the following?

	Very Satisfied	Somewhat Satisfied	Neither Satisfied nor Dissatisfied	Somewhat Dissatisfied	Very Dissatisfied
Quality of products	*How do you rate the following? Quality of products Very Satisfied	Quality of products Somewhat Satisfied	Quality of products Neither Satisfied nor Dissatisfied	Quality of products Somewhat Dissatisfied	Quality of products Very Dissatisfied
Services provided	Services provided Very Satisfied	Services provided Somewhat Satisfied	Services provided Neither Satisfied nor Dissatisfied	Services provided Somewhat Dissatisfied	Services provided Very Dissatisfied
On-time delivery	On-time delivery Very Satisfied	On-time delivery Somewhat Satisfied	On-time delivery Neither Satisfied nor Dissatisfied	On-time delivery Somewhat Dissatisfied	On-time delivery Very Dissatisfied
Availability of products	Availability of products Very Satisfied	Availability of products Somewhat Satisfied	Availability of products Neither Satisfied nor Dissatisfied	Availability of products Somewhat Dissatisfied	Availability of products Very Dissatisfied

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3. How satisfied are you with the following characteristics of our product/service?

	Very Satisfied	Somewhat Satisfied	Neither Satisfied nor Dissatisfied	Somewhat Dissatisfied	Very Dissatisfied
Price	*How satisfied are you with the following characteristics of our product/service? Price Very Satisfied	Price Somewhat Satisfied	Price Neither Satisfied nor Dissatisfied	Price Somewhat Dissatisfied	Price Very Dissatisfied
Purchase Experience	Purchase Experience Very Satisfied	Purchase Experience Somewhat Satisfied	Purchase Experience Neither Satisfied nor Dissatisfied	Purchase Experience Somewhat Dissatisfied	Purchase Experience Very Dissatisfied
Product Performance	Product Performance Very Satisfied	Product Performance Somewhat Satisfied	Product Performance Neither Satisfied nor Dissatisfied	Product Performance Somewhat Dissatisfied	Product Performance Very Dissatisfied

4. Do you have any additional comments?

Do you have any additional comments?

5. May we contact you if we have any questions? (optional)

May we contact you if we have any questions? (optional) Name
Company
Email Address

How Are We Doing?

*1. What is your overall satisfaction rating with our company?

*2. How do you rate the following?

*3. How satisfied are you with the following characteristics of our product/service?

4. Do you have any additional comments?

5. May we contact you if we have any questions? (optional)

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1. What is your overall satisfaction rating with our company?

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2. How do you rate the following?

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3. How satisfied are you with the following characteristics of our product/service?