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541-382-7710

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Customer Satisfaction Form

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Work Performance:

Completely Satisfied

Satisfied

Neither

Dissatisfied

Completely Dissatisfied

Phone Representative:

Completely Satisfied

Satisfied

Neither

Dissatisfied

Complete Dissatisfied

Overall Experience:

Completely Satisfied

Satisfied

Neither

Dissatisfied

Completely Dissatisfied

Employee Appearance:

Completely Satisfied

Satisfied

Neither

Dissatisfied

Completely Dissatisfied

Employee Attitude

Completely Satisfied

Satisfied

Neither

Dissatisfied

Completely Dissatisfied

Which is most important to you?:

Work Performance

Employee Appearance

Phone Representatives

Employee Attitude

Did our employee(s) protect your flooring from dirty shoes, tools, etc.?:

Yes

Did our employee(s) mention any additional services we offer?

Yes

Your service charge was:

More than expected

About right

Less than expected

Would you use our services again?:

Yes

Maybe

Would you recommend our services?:

Yes

Comments / Suggestions: Enter Your Message

Date of service: month/day/year

Technician's name: Enter Name

Your name: Enter Name (First & Last)

Address: Enter Address

City: Enter City

State: Enter State

Zip code: Enter Zip

Country: Enter Country

Phone: Enter Phone Number

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