Customer Satisfaction Survey Form

Dear Valued Customer,
Our goal is to be the best supplier of goods and services to you. As our customer, your constructive comments would be greatly appreaciated in order to help us continually improving our products and services to you. Please rate our service by circling on a scale of 0 to 10 with the highest number of '10' being fully satisfied, and the lower numbers representing relatively lesser satisfaction, '0' means not satisfied.

Company Name: Date:
Appraiser's Name:          
NoCriteriaNo Satisfaction Fully Satisfaction
1 Overall level of performance of Leuco Sales and services
2 On time delivery
3 Response time
4 Accuracy of info/tool/services
5 Product /Service quality
6 Handling complaint
7 Competitive price
8 Ability of customer service representatives
9 Ability of sales representatives
10 Positive attitude

NoGeneralNo Likely Most Likely
1 How likely is it that you would recommend Leuco to a friend or colleague?
2 How frequent you access Leuco Website?

Suggestion for improvement to exceed your expectations:
[Type Security code here]