Feedback Form: Administrative & Billing
Contact Name: (required)
Business Name: (required)
Equipment ID: (if applicable)
Phone Number: (required)
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Question Answer/Rating
Please rate accordingly: excellent very good good fair poor doesn't apply  
5 4 3 2 1 0  
In terms of helpfulness and friendliness, how would you rate the attitude of the person you spoke with at Ultrex? (rate)
Were you placed on hold? (yes/no)
if placed on hold, how long? (minutes)
if you were placed on hold, how acceptable would you rate the amount of time you were on placed on hold for?
(5 = better than acceptable, 3 = acceptable, and 1 = most unacceptable)		 (rate)
Please rate our ability to assist you and/or answer your question(s): (rate)
Would you be interested in receiving your monthly invoices via email? (yes/no)
   
Comments
Please provide any additional feedback you think may help us better serve you in the future. Thank you for your time.