* 1. Name.

* 2. Please enter your email address.

Thank you for contacting Portland Glass! We truly appreciate your feedback. We are always looking for ways to improve both our products and our services!

3. Please specify your age.

4. What is your gender?

6. Invoice Number

* 7. How did you hear about us? (check all that apply)

8. What type of work did we do for you? (check all that apply)

9. Would you consider us for (check all that apply):

10. Would you like more information about: (check all that apply)

11. Please Rate our Office Staff (1 being poor, 5 being excellent)

12. Please Rate our Technicians (1 being poor, 5 being excellent)

13. Would you recommend us?

14. Are there any areas where we could improve our products and\or services?

15. Is there anything else you think we should know?

* 16. May we use your comments in marketing materials?

* 17. Would you like to be on our email list for glass tips, news about special promotions and sales and general information about Portland Glass?

18. If you have any questions or concerns and would like Portland Glass to contact you, please provide your information below.

Thank you for your time!