Customer Opinion Survey.

Please provide your contact information (all fields are optional). Name   Telephone Number   E-mail Address   How long have you used [Company] [Product/Service]? Please select one ... Less than one month 1-6 months 6-12 months More than 1 year How often do you use [Product/Service]? Once a month or less Several times a month Several times a week Every day Other   Where do you primarily use [Product/Service]? At home At the office Other   Are you familiar with these related [Products/Services]? Please check all that apply. Product/Service 1 Product/Service 2 Product/Service 3 What do you consider to be the most important feature/benefit of the [Product/Service]? Feature/Benefit 1 Feature/Benefit 2 Feature/Benefit 3 What do you consider to be the weak points of the [Product/Service]? Please check all that apply. Price Functionality Design Versatility Reliability Other   Please rate your overall satisfaction with our [Product/Service]. Excellent Very Good Good Fair Poor Were our stuff and sales representatives helpful enough? Yes No Other   Were the billing issues handled efficiently? Yes No Please rate the after-sale support you received from [Company]. Excellent Very Good Good Fair Poor Please rate your overall purchase experience from [Company]. Excellent Very Good Good Fair Poor Please provide any additional comments or ideas you would like to share with us. Would you like our Customer Care group to contact you additionally? Yes No

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