Please answer each question with one of the following values:
5 - Completely Satisfied, 4 - Mostly Satisfied, 3 - Somewhat Satisfied,
2 - Mostly Dissatisfied, 1 - Completely Dissatisfied

Was the appliance we serviced for you still under the manufacturer warranty?
Yes No Not Sure

1. Was your call answered in a friendly, helpful and efficient manner?
<High 5 4 3 2 1 Low>

2. Was your service appointment convenient for you?
<High 5 4 3 2 1 Low>

3. Did we repair your appliance in a timely manner?
<High 5 4 3 2 1 Low>

4. Did our technician treat you and your property with respect?
<High 5 4 3 2 1 Low>

5. Was your appliance repaired to your satisfaction?
<High 5 4 3 2 1 Low>

6. How would you rate your overall experience with our company?
<High 5 4 3 2 1 Low>

7. Would you use our company again and/or recommend us to a friend or neighbor?
<High 5 4 3 2 1 Low>

8. Was there an employee who was especially helpful?
Yes No Not Sure  Name:

9. Reference Number - (Job Number, Invoice Number or your Phone Number)??

10. Please indicate how  you were referred to our company :
Family or Friend Previous Customer Retailer or Dealer Yellow Pages Manufacturer Internet Web Site Other  if other please specify

11.MAY WE HAVE YOUR E-MAIL ADDRESS ??
Yes No