Customer Survey

2. Name of Employee Serving You:
4. Date and Time of Service
   Date and Time of Service

   Date and Time of Service
5. Where were you helped?

   1. Toll Booth
   2. Office Counter
   3. Phone
   4. Email
7. First Name

   Optional

8. Last Name
10. Your Address

    Optional 

12. City
13. State
14. Zip Code
16. Your Email Address

    Optional

17. Your Phone Number

    Optional

19. Speed and Accuracy of Service

    1. Excellent
    2. Satisfactory
    3. Unsatisfactory
20. Knowledge, Skill of Staff

    1. Excellent
    2. Satisfactory
    3. Unsatisfactory
22. Courtesy, Friendliness of Staff

    1. Excellent
    2. Satisfactory
    3. Unsatisfactory
23. Neatness, Appearance of Staff

    1. Excellent
    2. Satisfactory
    3. Unsatisfactory
25. Please Explain Any Unsatisfactory Responses
Leave This Blank:


27. 1. Receive an email copy of this form.
28. Email address

    This field is not part of the form submission.

29. Submit

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