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* First Name : 
* Company : 
* Email Address : 
 
 
 
* How long have you used our products?
 
Less than 6 months
 
6 months to less than 1 year
 
1 year to less than 3 years
 
3 years to less than 5 years
 
5 years or more
 
 
 
* How frequently do you purchase from us?
 
Every day
 
Every week
 
Every 2 - 3 weeks
 
Every month
 
Every 2 - 3 months
 
Every 4 - 6 months
 
Once or twice a year
 
 
 
* How would you rate your level of satisfaction with us?
 
Highly satisfied
 
Somewhat satisfied
 
Neutral
 
Somewhat dissatisfied
 
Highly dissatisfied
 
 
 
* How can we improve to serve you better?
   
 
 
 
* How would you rate your overall level of satisfaction with us?
 
Highly satisfied
 
Somewhat satisfied
 
Neutral
 
Somewhat dissatisfied
 
Highly dissatisfied
 
Comment:
 
 
 
* How likely are you to continue using our products?
 
Very likely
 
Somewhat likely
 
Neutral
 
Somewhat unlikely
 
Very unlikely
 
 
 
Comments/Suggestions:
   
 
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