Customer Satisfaction Survey

Customer Satisfaction Feedback Form

Your opinion is important to us! We want to earn your business by earning your trust! It is our sincere desire to develop and nurture a long-term relationship with you, our customer. The more we know about your specific vehicle and your needs, the better we can serve you in the future. Please take a moment and complete the following questionnaire in regards to your recent visit. In consideration of your valuable time, we will send you a $10 mail-in rebate coupon good for any service at a Parts Plus Car Care Center. (Limit two coupons per person or household per year.)

1. Contact Information
Name:
Email:
Address:
City:
State:	AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY
Zip:
Phone:
2. Car Care Center & Service Information
Car Care Center:
Phone:
Work Order #:
Work Date:

3. Please indicate the level of service you received
		Poor	Fair	Good	Excellent
1. Service staff willingness to understand my problem
2 Explanation of the diagnosis and needed work on my vehicle
3. Vehicle returned to me free of grease, oil and fingerprints
4. Satisfaction with the work performed on my vehicle
5. Cleanliness and neatness of the Service Center
6. Likelihood that I will return for future service or repair work
My vehicle was completed on time		Yes	No
4. Comments
Please have a manager contact me		Yes	No

What improvements could we make in our service to you?
Thank you for responding. We appreciate your business.