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CLIENT & JOB INFORMATION

• Customer Name:
• Customer Address:
• Phone Number:
• Date of Service:
• Installer:
• Service Provided:

SATISFACTION QUESTIONS

• Was our Office Staff Courteous? Yes No 
• Was your Installer Courteous? Yes No 
• Was your Service Timely? Yes No 
• Was your Installer Knowledgeable? Yes No 
• Was jobsite left clean and orderly? Yes No 
• Did the Installer review basic operation of the new appliance/fixture? Yes No 

• What is your opinion of the quality of work performed? Excellent Good Average Poor Bad 
• Overall satisfaction of service? Excellent Good Average Poor Bad 

ADDITIONAL COMMENTS