Charlotte Water Customer Feedback
Survey

Question Title

1. What method of contact describes your interaction
with Charlotte Water?

Phone

In-Person

Letter/Door Hanger

Web Portal

Other (please specify)

Question Title

2. Date of Service

Type or Select Calendar

Date

Question Title

3. What service did you receive? Choose from the List. (Required.)

Water Turn-on

Water Turn-off

Meter Reading

High Bill Inspection

Water Line Repair

Water Quality

Water Meter Pressure/Flow Test Inspection

Equipment Replacement

Water and/or Sewer Installation

Sanitary Sewer Backup/Repair

Pre-Billing Quality Assurance Inspection

Other (please specify)

Question Title

4. How satisﬁed were you with the service that yo
received? Please select one option: 1 (very dissatisﬁed), 2 (Dissatisﬁed), 3 (neither satisﬁed or dissatisﬁed), 4 (satisﬁed) or 5 (very satisﬁed).

Question Title

5. Comments:

Question Title

6. Names of Charlotte Water staff members(s) who assisted you:

Question Title

7. Contact Information (optional)

Name:

Address:

Email:

Phone:

Charlotte Water Customer FeedbackSurvey

Question Title

* 1. What method of contact describes your interactionwith Charlotte Water?

Question Title

* 2. Date of Service

Question Title

* 3. What service did you receive? Choose from the List. (Required.)

Question Title

* 4. How satisﬁed were you with the service that yoreceived? Please select one option: 1 (very dissatisﬁed), 2 (Dissatisﬁed), 3 (neither satisﬁed or dissatisﬁed), 4 (satisﬁed) or 5 (very satisﬁed).

Question Title

* 5. Comments:

Question Title

* 6. Names of Charlotte Water staff members(s) who assisted you:

Question Title

* 7. Contact Information (optional)

Charlotte Water Customer Feedback
Survey

1. What method of contact describes your interaction
with Charlotte Water?

2. Date of Service

3. What service did you receive? Choose from the List. (Required.)

4. How satisﬁed were you with the service that yo
received? Please select one option: 1 (very dissatisﬁed), 2 (Dissatisﬁed), 3 (neither satisﬁed or dissatisﬁed), 4 (satisﬁed) or 5 (very satisﬁed).

5. Comments:

6. Names of Charlotte Water staff members(s) who assisted you:

7. Contact Information (optional)