General Information

Today’s Date:

Name:

Title:

Organization:

Work Address:

City:

State and Zip:

Phone Number:

Fax Number:

E-mail Address:

What is your area of expertise?

How long have you used our product?

If we need to get in touch with you, what is the best way for us to contact you?

In your most recent experiences, how satisfied are you with the following product attributes associated to our product and the support services provided by our organization?

Very Dissatisfied

Very Satisfied

a. Reliability

1

2

3

4

5

b. Performance

1

2

3

4

5

c. Innovation and New Technology

1

2

3

4

5

d. Ease of Use

1

2

3

4

5

e. Pre-sales Service

1

2

3

4

5

f. After Sales Support

1

2

3

4

5

g. Overall Satisfaction

1

2

3

4

5