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Customer Survey

Customer Survey

1. Please provide your name & contact information (Optional)

First Name
Last Name
Email Address
Phone Number

3. Where did you interact with our representative?

At a walk-in facility
On the phone
Via email or letter
S/he came to my home or business

How long did you have to wait for a customer service representative?

If Other, please explain

5. Please rate the professionalism and courtesy of the agent who served you

	4	3	2	1
Very Professional					Poor

What was the date you interacted with this staff person?

calendar

What was the time you interacted with this staff person?

Space Cell	Hour	Minute	AM/PM
Please indicate the time:	Hour	Minute	AM/PM

If Other, please explain

Is there a means by which we could encourage/enable you to pay bills on a timely basis?

Discount for early payment
Additional means of payment
Other

If Additional means of payment, please explain

If Other, please explain

8. Additional Comments or Suggestions