Product Survey for

1. We are in the:	Retail Business       Government/Municipality       Private User       Other
2. We operate:	Store	Distributorship	Government Agency	Individual	Other
3. Our business is considered:	Large	Medium	Small
4. We are located in:	City of:       Country of:
5. We purchased the following products:	;
; ;
6. Before using your products, we were having the following issues:
(a)
(b)
(c)
7. We have used your products for:	years	months	weeks
8. After this period we have witnessed the following results: (if you witnessed no results, please be honest with us)
9. I consider the ease of use as:	Difficult	Easy	Needs Improvement
10. I would like to see improvement in:	Packaging	Instructions	None	Other
11. After evaluating your products, we have concluded the following results:			Highly Favorable	Favorable
Not very favorable	Do Not Like
12. We could become a loyal customer and would order your products again:    Yes    No
13. We would like to see the following improvements or new products added to your line:
Thank you for allowing us to better understand your needs. We promise to consider your comments as we continue our quest to bring you the highest quality products.
Name:   (optional)

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