Exit Customer Survey Form Question Title * 1. Date Date / Time Date Question Title * 2. Agency Question Title * 3. Name/Title Question Title * 4. Telephone # Question Title * 5. Email Question Title * 6. Customer Purchase Order # Question Title * 7. Was your Sales Representative Helpful and Professional? Yes No, Please comment Question Title * 8. Did you recieve your shipment in a timely fashion? Yes No, please comment Question Title * 9. Did you receive exactly what you ordered? Yes No, please comment Question Title * 10. Did you receive prior notice (via email) of shipping tracking status? Yes No Question Title * 11. Would you have any objections to working with PCi Tec in the future? Yes No, please comment Question Title * 12. May PCi Tec reach out to you to discuss any IT issues your office may be facing? Yes No Additional Comments: Submit
