Customer Survey
Contact Information
Name*
E-mail Address*
Address*
 Phone Number*
City*
 Invoice Number*
Zip*
 *    Denotes required entry fields
Satisfaction
Completely Satisfied
 Satisfied
 Neutral
 Dissatisfied
 Completely Dissatisfied
Which one of the 4 listed
satisfaction ratings is most
important to you?
Our phone representative
Our performed work
1.
 2.
Our employee's appearance
3.
 4.
Our employee's attitude
Did we wear protective shoe coverings?
 Yes
 No
Did we protect your floor and furnishings with our Special Care treatment?
 Yes
 No
Our service fees were...
 Lower than
expected
 Just
Right
 Higher than
expected
Would you call us again?
 Yes
 No
Would you refer us to family or friends?
 Yes
 No
Additional Comments
May we use your comments in current or future
marketing?
Yes
Putting Faith Based Honesty and Integrity Back Into Service
…”Set an example of good works yourself, with integrity and dignity” - Titus 2:7
TECL# 24943
Christian Electricians
Local Electrical Service & Repair