Scale: 5=Completely Satisfied 4=Mostly Satisfied 3=Somewhat Satisfied 2=Mostly Dissatisfied 1=Completely Dissatisfied

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

2. Was your service appointment convenient for you? 5 4 3 2 1

3. Did we repair and/or diagnose your appliance in a timely manner?
5 4 3 2 1

4. Was our technician clean, neat, professional and friendly? 5 4 3 2 1

5. Did our technician leave the work area and the appliance clean? 5 4 3 2 1

6. Was your appliance repaired or diagnosed to your satisfaction? 5 4 3 2 1

7. How would you rate your overall experience with our company? 5 4 3 2 1

8. Did our technician explain that we service all types of appliances and/or ask if any other appliances need attention? Yes  No

9. Did our technician leave you a sticker and/or magnet? Yes  No

10. Would you use our company again and recommend us to others? Yes  No

Was there an employee who was especially helpful?
If so, could we have their name?

Comments or Question

You have my permission to publish my comments. Yes  No
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How were you referred to our company?
Family/Friend  Previous Customer  Yellow Pages  Retailer  Manufacturer
Internet/Website  Other: