Customer Survey

1. Were you satisfied with the work performed?*YesNo

2. What type of service was performed?*

3. Do you feel the work was done in a professional and efficient manner?*YesNo

4. Was the BELOMAN technician who serviced your home courteous?*YesNo

5. Upon completion of the work, was the cleanup satisfactory?*YesNo

6. Did you receive your homeowner’s manual?*YesNoN/A

7. Were operating instructions fully explained to you?*YesNoN/A

8. Based on your experience with BELOMAN, would you use our services in the future?*YesNo

9. Was your salesman knowledgeable on the products available?*YesNoN/A

10. Are you a member of our Discount Club?*YesNo

11. If not and you would like information about it, place your address or email here

12. Do you have any comments or suggestions?

13. May we use your comments for future advertising purposes?*YesNo

14. Please provide your name and address (optional)