First Name:

Last Name:

Phone #:

Email:

City:

Province/State:

How did you hear about us?

Product purchased or quoted?

What is your overall satisfaction rating with our company?

Very Satisfied

Somewhat Satisfied

Neither Satisfied Nor Dissatisfied

Somewhat Dissatisfied

Very Dissatisfied

Please tell us why you feel that way.

How likely are you to recommend our product to a friend or colleague?

Very Likely

Somewhat Likely

Neither Likely Nor Unlikely

Somewhat Unlikely

Very Unlikely

Please tell us why you feel that way.

Thinking of similar products offered by other companies, how would you compare our product to them?

Much better

Somewhat better

About the same

Somewhat worse

Much worse

Don’t know

Would you purchase our product again?

Definitely

Probably

Not sure

Probably not

Definitely not

Why do you feel that way about purchasing our product/service again?

Please rate your level of satisfaction with your sales representative in the following areas.

Professionalism

Very Satisfied

Somewhat Satisfied

Neither Satisfied Nor Dissatisfied

Somewhat Dissatisfied

Very Dissatisfied

Knowledge of the product

Very Satisfied

Somewhat Satisfied

Neither Satisfied Nor Dissatisfied

Somewhat Dissatisfied

Very Dissatisfied

Time taken to prepare quote

Very Satisfied

Somewhat Satisfied

Neither Satisfied Nor Dissatisfied

Somewhat Dissatisfied

Very Dissatisfied

If you have any additional comments about how we can improve your satisfaction with our products and services, please fill them in here.