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Customer Questionnaire


First name 
Last name
Address
City
State
ZIP code
Service date 
Invoice number
Service location
Technician name
Insurance company
Agent
Please rate our service in the following areas:

Courtesy of telephone customer service representative
Poor
Below Avg.
Good
Above Avg.
Excellent

Courtesy of Safelite® technician
Poor
Below Avg.
Good
Above Avg.
Excellent

Quality of work performed
Poor
Below Avg.
Good
Above Avg.
Excellent

Technician fulfilled the 5-Point Service Pledge
Poor
Below Avg.
Good
Above Avg.
Excellent

Overall service experience
Poor
Below Avg.
Good
Above Avg.
Excellent

Convenience of appointment
Poor
Below Avg.
Good
Above Avg.
Excellent

How quickly were we able to schedule your job?
Same day
Next day
2-4 days
4+ days

Did we schedule the job to meet your needs?
Yes     No

Would you recommend Safelite® to a friend?
Yes     No

If "no," why not


Additional comments


How did you find Safelite®?





 

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