Customer Feedback

Customer Satisfaction Questionnaire

Date of Survey: _______________________

Customer Company Name: ____________________________________________________

Customer Representative Name: _______________________________________________

Ask these questions as simply and directly as possible to easily get a yes, no or numerical answer. If additional notes are relevant, add them to the notes column to the right.

Survey Question Yes/No Notes
  1. Did ADX products perform as you expected?
  1. Are there any improvements or expectations you as the customer would like to bring to the attention of ADX?
  1. Are there any additional products or services you would like ADX to provide?
  1. Are there any additional questions, concerns or suggestions you would like to indicate to ADX? If so please describe below
  1. Did you receive your materials on time?

Additional comments or feedback from either the customer or person performing the survey in regards to the satisfaction of this customer and Integrity’s performance in meeting customer expectations: