Customer Feedback

Customer Satisfaction Questionnaire

Date of Survey: _______________________

Customer Company Name: ____________________________________________________

Customer Representative Name: _______________________________________________

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

Survey Questions Yes/No Notes
Did ADX products perform as you expected?
Are there any improvements or expectations you as the customer would like to bring to th attention of ADX?
Are there any additional products or services you would like ADX to provide?
Are there any additional questions, concerns, and/or suggestions you would like to indicate to ADX?
Did you receive your materials on time?

Additional comments and/or feedback: