[Company Name]

[Company Group, Division, Location]

Customer Satisfaction Survey

INTRODUCTION

From                           To                          

Company                           Company                          
Address                           Address                          
                                                   
                                                   
Email                           Email                          

Dear Mr./Ms.:

As a follow-up to the product(s)/services that our company has recently provided for you would you please
complete this short questionnaire and return it to my attention.

SURVEY
1. Did you receive the product(s)/services that you ordered? Yes No
Comments:

2. Where you satisfied with the product(s)/services that you ordered? Yes No
Comments:

3. Would you recommend our product(s)/services to another company? Yes No

Comments:

4. Will you need additional product(s)/services from our company in the future? Yes No
Comments:

Form No. _____ Rev No. _____