FAIL (the browser should render some flash content, not this).
Customer Survey Form

Please complete the survey to be entered in our monthly drawing for a $50.00 Visa Gift Card.  All entries are entered in the month service was rendered.  New drawing each month. Winner will be drawn on the last day of the month. Winner will be notified by phone.

 

For each item identified below, select the number
to the right that best fits your judgment of its quality.
Use the scale above to select the quality number.

Description/Identification of Survey Item

Scale

Poor < ---------------------- Good ------------------> Excellent

1. THE QUALITY OF THE WORK PERFORMED WAS 1 2 3 4 5
2. THE SERVICE SPECIALIST'S APPEARANCE WAS 1 2 3 4 5
3. SERVICE SPECIALIST'S ATTITUDES WAS 1 2 3 4 5
4. THE WORK AREA WAS CLEANED AND PUT BACK TOGETHER 1 2 3 4 5

5. WAS THE WORK COMPLETED TO YOUR SATISFACTION?
6. SERVICE CHARGE WAS:
7. WOULD YOU CHOOSE JEFF THE PLUMBER AGAIN?