Customer Response/Survey Form

Basic Information                                                                                                                        

Who Provides Your Service:      Kwik Tip Bins   Medico Waste Disposal  Medico Hygiene Services

Business Name:     Business Phone:  

 Contact Name:      Contact Phone:  

            Email: 

 
General Comments/Information
 Confidentiality
Your response to this survey will be collated internally by our Quality Department and will be kept in the strictest confidence

The data you supply will be used for our own internal statistical purposes only and will not be supplied to any third parties.

Please Indicate Your Opinion on the Quality of  Our Service
General: Excellent Good Fair Poor
Reliability: Excellent Good Fair Poor
Drivers: Excellent Good Fair Poor
Sales Personnel: Excellent Good Fair Poor
Accounts: Excellent Good Fair Poor
General Information
How have you heard about our services?
Yellow Pages Referral Sales Person Television
Radio Newspaper Internet Other
Did you find our website user friendly?: Yes No
Other Information
Suggestions:
 Concerns/Problems:
Issue 1 M024.doc