Contact Information

First Name *

Last Name

Street Address

Address Line 2

City

State

ZIP Code

Phone Number

Can the above number receive texts?

Yes

Secondary Phone Number

Can the above number receive texts?

Yes

Email address *

Confirm email address *

Job Number or Date of Service *

1. Did our technician arrive when expected?

Yes

2. Was the job completed to your satisfaction and expectations?

Poor		OK		Great

3. Did our technician adequately communicate the services performed, the associated charges and answer all your questions?

Poor		OK		Great

4. Was our Technician courteous and did he treat your home with respect?

Poor		OK		Great

5. Did our technician clean up the work area properly?

Poor		OK		Great

6. Was our office staff helpful and courteous?

Poor		OK		Great

7. Please rate your overall experience with Outstanding Custom Design.

Poor		OK		Great

8. What is the chance that you would recommend Outstanding Custom Design to others?

Poor		OK		Great

Is there any question or unresolved issue you may have where you would like us to call you?

Yes

Do you have any comments, concerns or suggestions about your latest experience with Outstanding Custom Design that you would like to share with us?