JX Peterbilt Customer Satisfaction Survey

*Which location did you visit?

*Which department assisted you?

Please rate the service you receivedon
the following scale: 5 (Excellent) - 1(Poor)

	5	4	3	2	1
*Staff courtesy
*General facility appearance
*Quality of service
*Quality of products
*Timeliness of service

*Was the pricing competitive?

Yes

*Did we meet your expectations?

Yes

*Will you continue to use our services?

Yes

*Would you recommend this dealership
to a friend or business associate?

Yes

If there was one thing you could change
about our business what would it be?

Comments:

*First Name:

*Email:

*Last Name:

Phone (Day):

(555-555-1234)

Company:

Cell Phone:

(555-555-1234)

Address:

City:

State:

Zip:

*May we contact you regarding your experience?

Yes

* = Required Field

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