Point of Service Question Title Question Title * 1. Department/Division (check one) City Manager City Clerk Code Enforcement Fire Rescue/Prevention Human Resources Parks, Recreation, Library Permitting Public Works (Solid Waste, Water, Streets) Utility Billing Other (please specify) Question Title * 2. Greeted me courteously and promptly Poor Fair Good Excellent Poor Fair Good Excellent Question Title * 3. Displayed professionalism at all time Poor Fair Good Excellent Poor Fair Good Excellent Question Title * 4. Showed concern about my problem/issue Poor Fair Good Excellent Poor Fair Good Excellent Question Title * 5. Helped resolve my problem/issue Poor Fair Good Excellent Poor Fair Good Excellent Question Title * 6. Comments/Suggestions Question Title * 7. If you would like a supervisor to contact you, please fill in the information requested. Name: Company: Address: Address 2: City/Town: State: -- select state -- AL AlabamaAK AlaskaAS American SamoaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareDC District of ColumbiaFM Federated States of MicronesiaFL FloridaGA GeorgiaGU GuamHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMH Marshall IslandsMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaMP Northern Mariana IslandsOH OhioOK OklahomaOR OregonPW PalauPA PennsylvaniaPR Puerto RicoRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVI Virgin IslandsVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY Wyoming ZIP: Country: Email Address: Phone Number: Done