* 1. Branch Location

* 2. Member Name (information required to qualify for quarterly drawing)

* 3. What type of transaction did you conduct today?

* 4. Who assisted you today? (If name unknown please reference your receipt for the Teller (Tlr) #)

* 5. Please rate your overall experience below:

  Exceptional Good Fair Poor
Friendly and Courteous Manner

* 6. Please rate your overall experience below:

  Exceptional Good Fair Poor
Knowledge of Products and Services

* 7. Please rate your overall experience below:

  Exceptional Good Fair Poor
Willingness to listen and respond to your needs

* 8. Please rate your overall experience below:

  Exceptional Good Fair Poor
Professionalism

* 9. Did the Member Service Representative offer you other products or services to meet your needs or enhance your banking experience?

* 10. We sincerely value your opinion, would you refer your Friends and Family to Five County Credit Union?

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