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

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* 2. Date of Service

Date

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

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

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* 5. Comments:

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* 6. Name(s) of the Charlotte Water staff member(s) who assisted you:

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* 7. Contact Information (optional):

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