Sample Customer Feedback Survey

If you want to take part in our research, please complete this short survey. It has less than 10 questions, and it will take less than 5 minutes for you to complete it. All responses received will be examined only in summary. We will not be selling or renting this survey's response information to any third parties.
Please enter your 10 character customer number.  If you do not have it, enter your 10 digit phone number.

Please enter a customer code if you have received one.


How would you rate us on the following: 
(1 is low, 5 is highest)

 1   2   3   4   5 
Use at Work 
Use at Home 
Overall Value 
In your opinion, has our company changed in the last year? How?
If you haven't you visited in the last 18 months, would you please tell us why?