Poor	Fair	Average	Good	Excellent
1.	Professionalism Helpfulness &    Courteousness
2.	Account Knowledge
3.	Accurate Messages
4.	Spelling
5.	Instructions are followed
6.	Hold Time
7.	Message Delivery
8.	Customer Service Responsiveness
9.	Resolution of Client Issues
10.	Value

YES NO Would you feel confident referring us to a friend?

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Contact Us . . .via E-mail: Via Phone: Either Is Fine:

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CUSTOMER INFORMATION - UPDATE: Please take a moment to update this following information.
Account Contact:				Ph:
Accounts Payable Contact:				Ph:
Accounts Payable e-mail:

AUTO PAY YES NO I am interested in setting up auto-pay (you will still receive an invoice and a receipt). I would rather go paperless and receive my invoice via e-mail.

Technical Contact:				Ph:
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