Customer Satisfaction Assessment Form
"Although NOT REQUIRED customer information will aid us in determining
clarity with the issues raised".
Name:
Organization:
Street Address:
City:
State/Province:
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip/Postal Code:
Country:
Work Phone:
Email:
Rating System:
Excellent -1
Above Average - 2
Average - 3
Below Average - 4
Poor - 5
Assessment Area
Customer Rating
Comments:
Customer Service
1
2
3
4
5
Quality
1
2
3
4
5
Responsiveness to Problems
1
2
3
4
5
Personnel
1
2
3
4
5
Packaging
1
2
3
4
5
Workmanship
1
2
3
4
5
Shipping/Receiving
1
2
3
4
5
Turnaround Times
1
2
3
4
5
Pricing
1
2
3
4
5
Overall Experience
1
2
3
4
5
Is there anything you would like to see
differently from us?
Thank You for helping Chicago Steel to improve in all facets of our business.
Privacy Statement