Electricman

Name
Address

City, State, Zip	, ,
E-mail Address

Date of Service (mm-dd-yyyy)

What is the level of satisfaction with
the service you received today?

Very Low Low High Very High

Would you recommend us to
a friend or relative?

Yes No

Do you have any suggestions on how we might improve our overall level of customer service?

Checking these boxes indicates a yes response.
May we share your comments with our staff and technicians?
May we use your comments (annonymously) on our website or advertising?