Customer Satisfaction Survey

Layout

Company: *

Address:

Address Line 1

City

State / Province / Region

Postal Code

Country

Layout

Equipment Model

Equipment Serial Number

Equipment Purchase Date

How satisfied are you with:

	0. N/A	1. Very Unsatisfied	2. Unsatisfied	3. Neutral	4. Satisfied	5. Very Satisfied
Delivery	0. N/ADelivery 0. N/A	1. Very UnsatisfiedDelivery 1. Very Unsatisfied	2. UnsatisfiedDelivery 2. Unsatisfied	3. NeutralDelivery 3. Neutral	4. SatisfiedDelivery 4. Satisfied	5. Very SatisfiedDelivery 5. Very Satisfied
Installation	0. N/AInstallation 0. N/A	1. Very UnsatisfiedInstallation 1. Very Unsatisfied	2. UnsatisfiedInstallation 2. Unsatisfied	3. NeutralInstallation 3. Neutral	4. SatisfiedInstallation 4. Satisfied	5. Very SatisfiedInstallation 5. Very Satisfied
Quality	0. N/AQuality 0. N/A	1. Very UnsatisfiedQuality 1. Very Unsatisfied	2. UnsatisfiedQuality 2. Unsatisfied	3. NeutralQuality 3. Neutral	4. SatisfiedQuality 4. Satisfied	5. Very SatisfiedQuality 5. Very Satisfied
Performance	0. N/APerformance 0. N/A	1. Very UnsatisfiedPerformance 1. Very Unsatisfied	2. UnsatisfiedPerformance 2. Unsatisfied	3. NeutralPerformance 3. Neutral	4. SatisfiedPerformance 4. Satisfied	5. Very SatisfiedPerformance 5. Very Satisfied
Spare Parts	0. N/ASpare Parts 0. N/A	1. Very UnsatisfiedSpare Parts 1. Very Unsatisfied	2. UnsatisfiedSpare Parts 2. Unsatisfied	3. NeutralSpare Parts 3. Neutral	4. SatisfiedSpare Parts 4. Satisfied	5. Very SatisfiedSpare Parts 5. Very Satisfied

How likely are you to:

	0. N/A	1. Very Unlikely	2. Unlikely	3. Neutral	4. Likely	5. Very Likely
Buy from us again	0. N/ABuy from us again 0. N/A	1. Very UnlikelyBuy from us again 1. Very Unlikely	2. UnlikelyBuy from us again 2. Unlikely	3. NeutralBuy from us again 3. Neutral	4. LikelyBuy from us again 4. Likely	5. Very LikelyBuy from us again 5. Very Likely
Endorse our product	0. N/AEndorse our product 0. N/A	1. Very UnlikelyEndorse our product 1. Very Unlikely	2. UnlikelyEndorse our product 2. Unlikely	3. NeutralEndorse our product 3. Neutral	4. LikelyEndorse our product 4. Likely	5. Very LikelyEndorse our product 5. Very Likely
Endorse our company	0. N/AEndorse our company 0. N/A	1. Very UnlikelyEndorse our company 1. Very Unlikely	2. UnlikelyEndorse our company 2. Unlikely	3. NeutralEndorse our company 3. Neutral	4. LikelyEndorse our company 4. Likely	5. Very LikelyEndorse our company 5. Very Likely

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