Customer survey

Please provide the following contact information:

First Name
Last Name
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Home Phone
FAX
E-mail

How would you rate our stores appearance?

1 2 3 4 5

How would you rate our inventory selection?

1 2 3 4 5

How would you rate our salespersons product knowledge?

1 2 3 4 5

How would you rate our delivery/installation service?

1 2 3 4 5

How would you rate our advertising?

1 2 3 4 5

How did you hear of us?

Television Radio Newspaper Direct Mail Other

How would you rate our overall customer service?

1 2 3 4 5