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Customer Satisfaction Response
Product Code:
Date:
Firm/Retail Name:
Your Address:
Your City:
Product Name:
Customer Reference No:
Place Of Purchase:
Your ZIP/Postal Code:
Your Telephone:
Please Select A Number From 1 to 5 Which Corresponds To Your Response:
1. Overall, Your Satisfaction With This Product(s) Design Was:
5
4
3
2
1
2. Overall, Your Satisfaction With This Product(s) Quality was:
5
4
3
2
1
3. Overall, Your Satisfaction With The Service Was:
5
4
3
2
1
4. Suggestions:
