Fields marked ** are required

First Name	**
Last Name	**
Address	**
City	**
State	**
Zip Code	**
Phone
E-mail	**

How did you hear about us?
Friend Relative Co-Worker Newspaper Ad or Article Yellow Pages Business Card Brochure Trade Show Internet Search **
How many times have you used us to work on your equipment or purchased products from us?
1 time per year 2 times per year 3 times per year more than 3 times per year I have never used your products or services
What is your overall feeling about our company?

Describe in detail a specific experience with us you were happy with.

Describe the one or two benefits that you have gotten from us that you value the most. Explain specifically what you've gotten out of them.

What do you BEST like about our products and/or services?

What can we do to improve our products and/or services?

What are the 3 most important things to you when you purchase products or service from us or similar businesses?
1)
2)
3)
What other products or services would you like us to offer?

May we use your comments in this survey in future marketing literature such as success stories from our clients?
By all means YES! I'd rather not **

Thank You for helping us to serve you better. We really appreciate the time you took to fill out this questionnaire.