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Date:

Name of Customer:

First Name
Middle Name
Last Name
Contact No :
First-time Customer
Repeat Customer

TYPE OF SERVICE RECEIVED :

Analytical services
Product development
Training
Information
Consultancy
Purchase of Product
Equipment/Facility Rental
Other (please specify)
Product name (if applicable):
Department from which goods/technology/service was received:

SATISFACTION LEVEL:

Indicate your level of satisfaction with the goods/technology/service received:

Highly satisfied
Satisfied
Indifferent
Dissatisfied
Highly dissatisfied

Did you receive the goods/technology/service on time?

yes
No

Would you use our service again?

yes
No

The cost of the goods/technology/service was:

Too expensive
Reasonably priced

How may we improve our service and website to you?

 

Thank you for your time and response

 
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