* 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!