Customer Service Evaluation Form
Name
First Name
Last Name
Date
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Date of Contact/Service
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Employee(s) Contacted
How was this contact made?
phone
mail
in person
online
This is a...
Please Select
Complaint
Comment
please select the appropriate option
Please describe the situation.
Has the problem been resolved?
Yes
No
Still waiting
If not, what kind of resolution are you looking for?
What recommendations would you make to the board to help them prevent a similar problem in the future?
Submit
Should be Empty: