SATISFACTION SURVEY FORM

Contact Information:
First Name
Last Name
Middle Initial
Address 1
Address 2
City
State/Province
Zip/Postal Code
Home Phone
E-mail
Confirm E-mail

Job Number:
Job Number or Date of Service:

Survey:
1. Did our technician arrive when expected?
Yes No
2. Was the job completed to your satisfaction and expectations?
Poor OK Great
3. Did our technician adequately communicate the services performed, the associated charges and answer all your questions?
Poor OK Great
4. Was our Technician courteous and did he treat your home with respect?
Poor OK Great
5. Did our technician clean up the work area properly?
Poor OK Great
6. Was our office staff helpful and courteous?
Poor OK Great
7. How do you rate our overall performance?
Poor OK Great
8. What is the chance that you would recommend Coffman Electric to a friend or relative?
Poor OK Great
9. Please rate your overall experience with Coffman Electric.
Poor OK Great

Comments:
Is there any question or unresolved issue you may have where you would like us to call you?
Yes No
Do you have any comments, concerns or suggestions about your latest experience with Coffman Electric that you would like to share with us?


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