Customer Satisfaction Survey

Customer Feedback Survey

Please let us know about your experience with our product and service.
Date

MonthDayYearHourMinutesAM/PM Option
Name*

First NameLast Name
Position*
Site Customer Name*
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Is this the first time you are using our Products and services?
Please tick current products and services we've provided?

Cleaning ProductsCleaning ServicesHire EquipmentsRepair of Cleaning Machinery
Would you recommend it to your friends and colleagues?

YesNo
What are your impressions of the products / services we provide you?
How can we improve the quality of the products / services we provide you?
Do you have any suggestions to improve our product and service?
What is your perception of the pricing for the products / services we provide you?
In what ways should we improve our products / services, our marketing or our delivery to you?
How do you perceive us with respect to our competitors?
Any thoughts you'd like to share with our organization on how we can serve you better:
How satisfied are you with our company overall?

Very SatisfiedSatisfiedUndecidedUnsatisfiedVery Unsatisfied
Please leave your email address if you would like us to contact you regarding any questions.
Respondent's Name:
E-mail Address
Thank you for completing our survey.
Enter the message as it's shown*
Should be Empty:

Customer Feedback Survey