Customer Satisfaction Form
Form: 8.2.1-1	Rev. Date: 03/20/2008	Rev: NC

Completed by:
Company Representing:
Title:
Email:
Phone:
Fax:

We are asking you to spend a few minutes out of your busy day to respond to our survey. The information you provide will help us improve our products and services for our organization. Using a scale from 1 to 10 (1 being Poor, 10 being excellent and 5 being average), please select the number representing our performance:
	0	1	2	3	4	5	6	7	8	9	10
Promptness of our response to request for quote
Delivery of product according to delivery date
Satisfactory response to change in delivery requirements
Competitive pricing of product(s)
Quality level as-received at your facility
Response to quality issues
Correctness of shipping documentation
Your perception of our commitment to continuous improvement
Please give an example of what you like least about dealing with our company
Please give an example of what you like best about our company