Customer Feedback Form

Establishment Name from appointment:

Establishment Phone from appointment:

Appointment Information

Was Contact Name, Establishment Name and address correct?
YesNo

If not, what was incorrect?

Did you leave a price?
YesNo

Are you following up?
YesNo

Why or why not are you following up?

Did you close the deal?
YesNo

Refused Appointment?
YesNo

Explain:

Additional Comments:

If a replacement is being requested, it will only be considered if within 24 hours of the day of the appointment. No exceptions will be made.