Service Evaluation Form

<body topmargin=0 leftmargin=0 marginheight=0 marginwidth=0> <table cellpadding=0 cellspacing=0 border=0><tr> <td valign="top" colspan=2 height=85 BGCOLOR="#FFFFFF" TEXT="#080000"> <div> <FONT SIZE="5" COLOR="#000000" FACE="Arial" ><B>Alpine Stove & Chimney Service</B></FONT><FONT SIZE="1" COLOR="#000000" FACE="Arial" ><B>     </B></FONT><B>|     </B><A HREF="index.htm" TARGET="_top" TITLE="Alpine Stove Chimney Service"><U><B>home</B></U></A></div> <div> <A HREF="id21.htm" TARGET="_top" TITLE="Retail Stores "><U>Retail Store's </U></A>   |   <A HREF="id63.htm" TARGET="_top" TITLE="Employment "><U>Employment </U></A>   |   <A HREF="id19.htm" TARGET="_top" TITLE="Location"><U>Location</U></A>   |   <A HREF="id44.htm" TARGET="_top" TITLE="Manufacturers Links"><U>Manufacturers Links</U></A>   |   <A HREF="id23.htm" TARGET="_top" TITLE="Products and Services"><U>Products and Services</U></A>   |   <A HREF="id41.htm" TARGET="_top" TITLE="Product Information/Contact Form"><U>Product Information/Contact Form</U></A>   |   <B>Service Evaluation Form</B>   |   <A HREF="id18.htm" TARGET="_top" TITLE="Sales Items"><U>Sales Items</U></A></div> <DIV ALIGN="LEFT"></DIV> <div> </div> </td> </tr><tr> <td valign="top" width=180 BGCOLOR="#990033" TEXT="#080000"> <div> <B>Thank you for taking the time to fill out this form.</B></div> <div> <B>Based on the results we will be able to understand which area's of our service need improvement.</B></div> <div> <B>Our goal is to provide the best service possible. Your feedback helps us to achieve this goal.</B></div> <div> <B>Many thanks from. </B></div> <div> <B>The team at Alpine Stove & Chimney Service.</B></div> </td> <td valign="top" height=395 BGCOLOR="#FFFFFF" TEXT="#080000"> <div> <I>Service Evaluation Form</I></div> <DIV ALIGN="LEFT"></DIV> <div> <IMG SRC="245221f0.jpg" border=0 width="34" height="31" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></div> <bR> <div> To help us continue providing our customers with the highest quality service, we would appreciate a few minutes of your time to evaluate the service you received from our personnel. Please complete this evaluation form and submit back to us.</div> <bR> <div>    <form enctype="multipart/form-data" method="post" action="http://www.freedback.com/mail.php" accept-charset="UTF-8"> <div> <input type="hidden" name="acctid" id="acctid" value="aven8plobqnp6t6p" /> <input type="hidden" name="formid" id="formid" value="256918" /> <input type="hidden" name="required_vars" id="required_vars" value="name,email" /> </div> <table cellspacing="5" cellpadding="5" border="0"> <tr> <td valign="top"> <strong>Name:</strong> </td> <td valign="top"> <input type="text" name="name" id="name" size="40" value="" /> </td> </tr> <tr> <td valign="top"> <strong>Email Address:</strong> </td> <td valign="top"> <input type="text" name="email" id="email" size="40" value="" /> </td> </tr> <tr> <td valign="top"> <strong>Name of person providing service (if known).</strong> </td> <td valign="top"> <input type="text" name="field-f3727b695e7964f" id="field-f3727b695e7964f" size="40" value="" /> </td> </tr> <tr> <td valign="top"> <strong>SALESPERSON: Personal appearance?</strong> </td> <td valign="top"> <input type="radio" name="field-278143e0b2b96ea" id="field-278143e0b2b96ea_0" value="Excellent" /> Excellent<br/> <input type="radio" name="field-278143e0b2b96ea" id="field-278143e0b2b96ea_1" value="Good" /> Good<br/> <input type="radio" name="field-278143e0b2b96ea" id="field-278143e0b2b96ea_2" value="Fair" /> Fair<br/> </td> </tr> <tr> <td valign="top"> <strong>Product Knowledge?</strong> </td> <td valign="top"> <input type="radio" name="field-64c0318d6c78db3" id="field-64c0318d6c78db3_0" value="Excellent" /> Excellent<br/> <input type="radio" name="field-64c0318d6c78db3" id="field-64c0318d6c78db3_1" value="Good" /> Good<br/> <input type="radio" name="field-64c0318d6c78db3" id="field-64c0318d6c78db3_2" value="Fair" /> Fair<br/> </td> </tr> <tr> <td valign="top"> <strong>Guidance to a successful purchase? </strong> </td> <td valign="top"> <input type="radio" name="field-fc9563555b84bec" id="field-fc9563555b84bec_0" value="Excellent" /> Excellent<br/> <input type="radio" name="field-fc9563555b84bec" id="field-fc9563555b84bec_1" value="Good" /> Good<br/> <input type="radio" name="field-fc9563555b84bec" id="field-fc9563555b84bec_2" value="Fair" /> Fair<br/> </td> </tr> <tr> <td valign="top"> <strong>Follow-up during/after sale/installation?</strong> </td> <td valign="top"> <input type="radio" name="field-a4a0e0251576059" id="field-a4a0e0251576059_0" value="Excellent" /> Excellent<br/> <input type="radio" name="field-a4a0e0251576059" id="field-a4a0e0251576059_1" value="Good" /> Good<br/> <input type="radio" name="field-a4a0e0251576059" id="field-a4a0e0251576059_2" value="Fair" /> Fair<br/> </td> </tr> <tr> <td valign="top"> <strong>Your overall satisfaction? </strong> </td> <td valign="top"> <input type="radio" name="field-63f628640078da2" id="field-63f628640078da2_0" value="Excellent" /> Excellent<br/> <input type="radio" name="field-63f628640078da2" id="field-63f628640078da2_1" value="Good" /> Good<br/> <input type="radio" name="field-63f628640078da2" id="field-63f628640078da2_2" value="Fair" /> Fair<br/> </td> </tr> <tr> <td valign="top"> <strong>SERVICE/DELIVERY DEPARTMENT: Prompt scheduling?</strong> </td> <td valign="top"> <input type="radio" name="field-0fc293aba47256a" id="field-0fc293aba47256a_0" value="Excellent" /> Excellent<br/> <input type="radio" name="field-0fc293aba47256a" id="field-0fc293aba47256a_1" value="Good" /> Good<br/> <input type="radio" name="field-0fc293aba47256a" id="field-0fc293aba47256a_2" value="Fair" /> Fair<br/> </td> </tr> <tr> <td valign="top"> <strong>Courteousness/Helpful? </strong> </td> <td valign="top"> <input type="radio" name="field-473ccdd9a456d6d" id="field-473ccdd9a456d6d_0" value="Excellent" /> Excellent<br/> <input type="radio" name="field-473ccdd9a456d6d" id="field-473ccdd9a456d6d_1" value="Good" /> Good<br/> <input type="radio" name="field-473ccdd9a456d6d" id="field-473ccdd9a456d6d_2" value="Fair" /> Fair<br/> </td> </tr> <tr> <td valign="top"> <strong>Scheduled time as promised?</strong> </td> <td valign="top"> <input type="radio" name="field-4acc881093a67d2" id="field-4acc881093a67d2_0" value="Excellent" /> Excellent<br/> <input type="radio" name="field-4acc881093a67d2" id="field-4acc881093a67d2_1" value="Good" /> Good<br/> <input type="radio" name="field-4acc881093a67d2" id="field-4acc881093a67d2_2" value="Fair" /> Fair<br/> </td> </tr> <tr> <td valign="top"> <strong>Product knowledge?</strong> </td> <td valign="top"> <input type="radio" name="field-2d291a5fb322044" id="field-2d291a5fb322044_0" value="Excellent" /> Excellent<br/> <input type="radio" name="field-2d291a5fb322044" id="field-2d291a5fb322044_1" value="Good" /> Good<br/> <input type="radio" name="field-2d291a5fb322044" id="field-2d291a5fb322044_2" value="Fair" /> Fair<br/> </td> </tr> <tr> <td valign="top"> <strong>Personal appearance?</strong> </td> <td valign="top"> <input type="radio" name="field-8b7ec3533330185" id="field-8b7ec3533330185_0" value="Excellent" /> Excellent<br/> <input type="radio" name="field-8b7ec3533330185" id="field-8b7ec3533330185_1" value="Good" /> Good<br/> <input type="radio" name="field-8b7ec3533330185" id="field-8b7ec3533330185_2" value="Fair" /> Fair<br/> </td> </tr> <tr> <td valign="top"> <strong>Job cleanup?</strong> </td> <td valign="top"> <input type="radio" name="field-08768d9444916bf" id="field-08768d9444916bf_0" value="Excellent" /> Excellent<br/> <input type="radio" name="field-08768d9444916bf" id="field-08768d9444916bf_1" value="Good" /> Good<br/> <input type="radio" name="field-08768d9444916bf" id="field-08768d9444916bf_2" value="Fair" /> Fair<br/> </td> </tr> <tr> <td valign="top"> <strong>Overall satisfaction?</strong> </td> <td valign="top"> <input type="radio" name="field-bddce8f0bc919fa" id="field-bddce8f0bc919fa_0" value="Excellent" /> Excellent<br/> <input type="radio" name="field-bddce8f0bc919fa" id="field-bddce8f0bc919fa_1" value="Good" /> Good<br/> <input type="radio" name="field-bddce8f0bc919fa" id="field-bddce8f0bc919fa_2" value="Fair" /> Fair<br/> </td> </tr> <tr> <td valign="top"> <strong>FRIENDLY GREETINGS: From salesperson?</strong> </td> <td valign="top"> <input type="radio" name="field-d776d85bda58a26" id="field-d776d85bda58a26_0" value="Excellent" /> Excellent<br/> <input type="radio" name="field-d776d85bda58a26" id="field-d776d85bda58a26_1" value="Good" /> Good<br/> <input type="radio" name="field-d776d85bda58a26" id="field-d776d85bda58a26_2" value="Fair" /> Fair<br/> </td> </tr> <tr> <td valign="top"> <strong>From service technician? </strong> </td> <td valign="top"> <input type="radio" name="field-3003edc246775a0" id="field-3003edc246775a0_0" value="Excellent" /> Excellent<br/> <input type="radio" name="field-3003edc246775a0" id="field-3003edc246775a0_1" value="Good" /> Good<br/> <input type="radio" name="field-3003edc246775a0" id="field-3003edc246775a0_2" value="Fair" /> Fair<br/> </td> </tr> <tr> <td valign="top"> <strong>From service manager?</strong> </td> <td valign="top"> <input type="radio" name="field-085bef74306b820" id="field-085bef74306b820_0" value="Excellent" /> Excellent<br/> <input type="radio" name="field-085bef74306b820" id="field-085bef74306b820_1" value="Good" /> Good<br/> <input type="radio" name="field-085bef74306b820" id="field-085bef74306b820_2" value="Fair" /> Fair<br/> </td> </tr> <tr> <td valign="top"> <strong>Overall impression?</strong> </td> <td valign="top"> <input type="radio" name="field-5f4725ead5c469d" id="field-5f4725ead5c469d_0" value="Excellent" /> Excellent<br/> <input type="radio" name="field-5f4725ead5c469d" id="field-5f4725ead5c469d_1" value="Good" /> Good<br/> <input type="radio" name="field-5f4725ead5c469d" id="field-5f4725ead5c469d_2" value="Fair" /> Fair<br/> </td> </tr> <tr> <td valign="top"> <strong>PRODUCTS: Availability?</strong> </td> <td valign="top"> <input type="radio" name="field-d24f384c6f8070f" id="field-d24f384c6f8070f_0" value="Excellent" /> Excellent<br/> <input type="radio" name="field-d24f384c6f8070f" id="field-d24f384c6f8070f_1" value="Good" /> Good<br/> <input type="radio" name="field-d24f384c6f8070f" id="field-d24f384c6f8070f_2" value="Fair" /> Fair<br/> </td> </tr> <tr> <td valign="top"> <strong>Quality? </strong> </td> <td valign="top"> <input type="radio" name="field-e8c7a881bf6616d" id="field-e8c7a881bf6616d_0" value="Excellent" /> Excellent<br/> <input type="radio" name="field-e8c7a881bf6616d" id="field-e8c7a881bf6616d_1" value="Good" /> Good<br/> <input type="radio" name="field-e8c7a881bf6616d" id="field-e8c7a881bf6616d_2" value="Fair" /> Fair<br/> </td> </tr> <tr> <td valign="top"> <strong>Value?</strong> </td> <td valign="top"> <input type="radio" name="field-d31618ca0a973e5" id="field-d31618ca0a973e5_0" value="Excellent" /> Excellent<br/> <input type="radio" name="field-d31618ca0a973e5" id="field-d31618ca0a973e5_1" value="Good" /> Good<br/> <input type="radio" name="field-d31618ca0a973e5" id="field-d31618ca0a973e5_2" value="Fair" /> Fair<br/> </td> </tr> <tr> <td valign="top"> <strong>Product performance?</strong> </td> <td valign="top"> <input type="radio" name="field-3288a0341854ed4" id="field-3288a0341854ed4_0" value="Excellent" /> Excellent<br/> <input type="radio" name="field-3288a0341854ed4" id="field-3288a0341854ed4_1" value="Good" /> Good<br/> <input type="radio" name="field-3288a0341854ed4" id="field-3288a0341854ed4_2" value="Fair" /> Fair<br/> </td> </tr> <tr> <td valign="top"> <strong>Pricing?</strong> </td> <td valign="top"> <input type="radio" name="field-586293a7cc6e5be" id="field-586293a7cc6e5be_0" value="Excellent" /> Excellent<br/> <input type="radio" name="field-586293a7cc6e5be" id="field-586293a7cc6e5be_1" value="Good" /> Good<br/> <input type="radio" name="field-586293a7cc6e5be" id="field-586293a7cc6e5be_2" value="Fair" /> Fair<br/> </td> </tr> <tr> <td valign="top"> <strong>How did you learn about us?</strong> </td> <td valign="top"> <textarea name="field-6a8fa2b50a5a78c" id="field-6a8fa2b50a5a78c" rows="6" cols="40"></textarea> </td> </tr> <tr> <td valign="top"> <strong>Have you used our service before?</strong> </td> <td valign="top"> <input type="radio" name="field-b66787b25d5a2c7" id="field-b66787b25d5a2c7_0" value="Yes" /> Yes<br/> <input type="radio" name="field-b66787b25d5a2c7" id="field-b66787b25d5a2c7_1" value="No" /> No<br/> </td> </tr> <tr> <td valign="top"> <strong>Will you return or recommend us? </strong> </td> <td valign="top"> <input type="radio" name="field-4047c5bc9f20360" id="field-4047c5bc9f20360_0" value="Yes" /> Yes<br/> <input type="radio" name="field-4047c5bc9f20360" id="field-4047c5bc9f20360_1" value="No" /> No<br/> </td> </tr> <tr> <td valign="top"> <strong>Comments?</strong> </td> <td valign="top"> <textarea name="field-11cadd8245df6fe" id="field-11cadd8245df6fe" rows="6" cols="40"></textarea> </td> </tr> <tr> <td valign="top"> <strong>Were you briefed on the operation and care of your purchase? </strong> </td> <td valign="top"> <input type="radio" name="field-bb38f1559c1065b" id="field-bb38f1559c1065b_0" value="Yes" /> Yes<br/> <input type="radio" name="field-bb38f1559c1065b" id="field-bb38f1559c1065b_1" value="No" /> No<br/> </td> </tr> <tr> <td valign="top"> <strong>Please share ideas on how to improve our service:</strong> </td> <td valign="top"> <textarea name="field-ccb58bc80ffeb1b" id="field-ccb58bc80ffeb1b" rows="6" cols="40"></textarea> </td> </tr> <tr> <td colspan="2" align="center"> <input type="submit" value=" Submit Form " /> </td> </tr> </table> </form> <br><center><font face="Arial, Helvetica" size="1"><b> <a href="http://www.freedback.com">free forms</a> </b></font></center>   </div> <bR> <bR> </td> </tr></table></body>