Customer Survey Form

• First Name: *
  
  Last Name: *
  
  Email Address: *
  
  Work Telephone:*
  
  Work Fax:
  
  Company Name: *
  
  Company Address: *
  
  Company City: *
  
  Company State:
  
  Company Country: *
  
  Brief Description of Product or Service Purchased:
  

  Please rate the following statements using a 1 to 7 score
  1 = Poor
  4 = Satisfactory
  7 = Excellent

  Timely Delivery of Shipment:
  Choose Your Score... 1 - Poor 2 3 4 - Satisfactory 5 6 7 - Excellent
  Satisfaction with the Product:
  Choose Your Score... 1 - Poor 2 3 4 - Satisfactory 5 6 7 - Excellent
  Satisfaction with the Overall Service Provided by ReeferParts:
  Choose Your Score... 1 - Poor 2 3 4 - Satisfactory 5 6 7 - Excellent
  Please enter comments below: