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Customer Survey Form
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Customer Survey Form
Name
*
First
Last
Email address
*
1. How likely is it that you would recommend this company to a friend or colleague? 1 - Not at all likely 10 - Extremely likely
1
2
3
4
5
6
7
8
9
10
2. Overall, how satisfied or dissatisfied are you with our company?
Very satisfied
Somewhat satisfied
Neither satisfied nor dissatisfied
Somewhat dissatisfied
Very dissatisfied
3. How would you rate the quality of the product?
Very high quality
High quality
Neither high nor low quality
Low quality
Very low quality
4. How long have you been a customer of our company?
This is my first purchase
Less than six months
Six months to a year
1 - 2 years
3 or more years
I haven't made a purchase yet
5. How likely are you to purchase any of our products again?
Extremely likely
Very likely
Somewhat likely
Not so likely
Not at all likely
6. Do you have any other comments, questions, or concerns?
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Email address
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