First, What kind of comment would you like to send?

Feedback Complaint Problem Suggestion Praise

Next, Please share some background information with us:

First Name		M.I.		Last Name
E-mail
Tel		FAX
Company Name
Job Title
Address
City	State Zip

Please contact me as soon as possible regarding this matter.

Now, Can you please rate our company in a few areas (Please use honest answers as this feedback will is geared to helping us better our company):

Overall, How would you rate our website (1 being extremely poor, and 7 being excellent):

1 2 3 4 5 6 7 N/A

Overall, How would you rate our company (1 being extremely poor, and 7 being excellent):

1 2 3 4 5 6 7 N/A

Overall, How would you rate our products (1 being extremely poor, and 7 being excellent):

1 2 3 4 5 6 7 N/A

Overall, How would you rate our services (1 being extremely poor, and 7 being excellent):

1 2 3 4 5 6 7 N/A

Overall, How would you rate our prices (1 being extremely poor, and 7 being excellent):

1 2 3 4 5 6 7 N/A

Overall, How would you rate our people (1 being extremely poor, and 7 being excellent):

1 2 3 4 5 6 7 N/A

Overall, How would you rate our professionalism (1 being extremely poor, and 7 being excellent):

1 2 3 4 5 6 7 N/A

Overall, How would you rate our response time (1 being extremely poor, and 7 being excellent):

1 2 3 4 5 6 7 N/A

Would you consider My Supplement Guy a good corporate citizen? (1 being extremely poor, and 7 being excellent)

1 2 3 4 5 6 7 N/A

In your opinion, what is the one thing we do best?

In your opinion, what is the one thing we do worst?

Do you have any other comments or suggestions?

In the future ...

We are planning to launch a quarterly publication to offer advice in business, when we release this publication would you like to receive it?

Would you like to receive discounts and coupons from us?

Would you like to receive discounts and coupons from our business partners?