Samsung mobiles survey form

Customer Information:
Customer Name
First NameLast Name
Address
Street Address
Street Address Line 2
CityState / Province
Postal / Zip CodeCountry
Contact Number
Area CodePhone Number
E-mail
How long have you been using this product and why?
Write your comments and suggestions about our products in comparison with other competitors:
Are you satisfied with our product performance? share your opinions:
Tell us something about your shopping experiences to buy our product:
Would you like to continue with our product? if No why:
What kind of changes would you like to see in our products so as to enhance your satisfaction level?
Thank you for completing this survey!
Should be Empty:

Customer Information: