Customer Feedback Genesis

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* 1. Please provide the following information:

Name:

Company:

Mailing Address:

Address Line 2:

City, State, Zip:

Email Address:

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* 2. Overall, how satisfied are you with Genesis Technologies?

Very Satisfied

Somewhat Satisfied

Neutral

Somewhat Dissatisfied

Very Dissatisfied

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* 3. Please rate the following statements using a scale from 1-5.

	Very Likely (5)	Somewhat Likely (4)	Neutral (3)	Somewhat Unlikely (2)	Very Unlikely (1)
How likely are you to continue to choose Genesis Technologies?	How likely are you to continue to choose Genesis Technologies? Very Likely (5)	How likely are you to continue to choose Genesis Technologies? Somewhat Likely (4)	How likely are you to continue to choose Genesis Technologies? Neutral (3)	How likely are you to continue to choose Genesis Technologies? Somewhat Unlikely (2)	How likely are you to continue to choose Genesis Technologies? Very Unlikely (1)
How likely are you to recommend the Genesis Technologies Group to a friend/associate?	How likely are you to recommend the Genesis Technologies Group to a friend/associate? Very Likely (5)	How likely are you to recommend the Genesis Technologies Group to a friend/associate? Somewhat Likely (4)	How likely are you to recommend the Genesis Technologies Group to a friend/associate? Neutral (3)	How likely are you to recommend the Genesis Technologies Group to a friend/associate? Somewhat Unlikely (2)	How likely are you to recommend the Genesis Technologies Group to a friend/associate? Very Unlikely (1)

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* 4. Please rate the following statements using a scale from 1-5.

	Very True (5)	Somewhat True (4)	Neutral (3)	Somewhat Untrue (2)	Very Untrue (1)
1. The Genesis Technologies Group is a name I can trust.	1. The Genesis Technologies Group is a name I can trust. Very True (5)	1. The Genesis Technologies Group is a name I can trust. Somewhat True (4)	1. The Genesis Technologies Group is a name I can trust. Neutral (3)	1. The Genesis Technologies Group is a name I can trust. Somewhat Untrue (2)	1. The Genesis Technologies Group is a name I can trust. Very Untrue (1)
2. The Genesis Technologies Group always delivers on what they promise.	2. The Genesis Technologies Group always delivers on what they promise. Very True (5)	2. The Genesis Technologies Group always delivers on what they promise. Somewhat True (4)	2. The Genesis Technologies Group always delivers on what they promise. Neutral (3)	2. The Genesis Technologies Group always delivers on what they promise. Somewhat Untrue (2)	2. The Genesis Technologies Group always delivers on what they promise. Very Untrue (1)
3. The Genesis Technologies Group always treats me with respect.	3. The Genesis Technologies Group always treats me with respect. Very True (5)	3. The Genesis Technologies Group always treats me with respect. Somewhat True (4)	3. The Genesis Technologies Group always treats me with respect. Neutral (3)	3. The Genesis Technologies Group always treats me with respect. Somewhat Untrue (2)	3. The Genesis Technologies Group always treats me with respect. Very Untrue (1)
4. The Genesis Technologies Group is the perfect company for people like me.	4. The Genesis Technologies Group is the perfect company for people like me. Very True (5)	4. The Genesis Technologies Group is the perfect company for people like me. Somewhat True (4)	4. The Genesis Technologies Group is the perfect company for people like me. Neutral (3)	4. The Genesis Technologies Group is the perfect company for people like me. Somewhat Untrue (2)	4. The Genesis Technologies Group is the perfect company for people like me. Very Untrue (1)
5. If a problem arises I can always count on The Genesis Technologies Group to reach a fair and satisfactory resolution.	5. If a problem arises I can always count on The Genesis Technologies Group to reach a fair and satisfactory resolution. Very True (5)	5. If a problem arises I can always count on The Genesis Technologies Group to reach a fair and satisfactory resolution. Somewhat True (4)	5. If a problem arises I can always count on The Genesis Technologies Group to reach a fair and satisfactory resolution. Neutral (3)	5. If a problem arises I can always count on The Genesis Technologies Group to reach a fair and satisfactory resolution. Somewhat Untrue (2)	5. If a problem arises I can always count on The Genesis Technologies Group to reach a fair and satisfactory resolution. Very Untrue (1)

Comments

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* 5. Please rate the Genesis Technologies Group on the following attributes using a scale from 1-5.

	Very Well (5)	Somewhat Well (4)	Neutral (3)	Somewhat Poorly (2)	Very Poorly (1)
Professionalism	Professionalism Very Well (5)	Professionalism Somewhat Well (4)	Professionalism Neutral (3)	Professionalism Somewhat Poorly (2)	Professionalism Very Poorly (1)
Quality of Products/Services	Quality of Products/Services Very Well (5)	Quality of Products/Services Somewhat Well (4)	Quality of Products/Services Neutral (3)	Quality of Products/Services Somewhat Poorly (2)	Quality of Products/Services Very Poorly (1)
Addressing Customer's Needs	Addressing Customer's Needs Very Well (5)	Addressing Customer's Needs Somewhat Well (4)	Addressing Customer's Needs Neutral (3)	Addressing Customer's Needs Somewhat Poorly (2)	Addressing Customer's Needs Very Poorly (1)
Communication	Communication Very Well (5)	Communication Somewhat Well (4)	Communication Neutral (3)	Communication Somewhat Poorly (2)	Communication Very Poorly (1)
Price	Price Very Well (5)	Price Somewhat Well (4)	Price Neutral (3)	Price Somewhat Poorly (2)	Price Very Poorly (1)

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* 6. Additional Comments or Feedback: