We Value Your Feedback!

We would appreciate it if you would take a few minutes to share your thoughts so we can better serve you in the future.

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. If you would like to receive our monthly newsletter, place your email here :

13. Do you have any comments or suggestions?

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

15. Please provide your name and address (optional)

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