Questions marked with an asterisk (*) are mandatory.

	1. * Tell Us About Yourself
	Name Company Address 1 Address 2 City/Town State/Province Zip/Postal Code Country Email Address

	2. * Parts or Service Invoice # (Enter your invoice number here)

	3. * Helpfull attitude of parts/service personnel
	Very Helpful Helpful Somewhat Helpful Not Helpful 1 2 3 4

	4. * Knowledgeable Staff
	Very Knowledgeable Knowledgeable Somewhat Knowledgeable Not Knowledgeable 1 2 3 4

	5. * Parts and/or Service work correct the first time
	YesNo Additional Comment

	6. * Answered my questions
	Yes No I had no questions

	7. * Shows appreciation for my business
	Excellent Good Fair Poor 1 2 3 4

	8. (SERVICE DEPT ONLY) Communicates estimate & quote changes as appropriate
	Excellent Good Fair Poor 1 2 3 4

	9. * Parts and/or Truck ready when promised
	Excellent Good Fair Poor 1 2 3 4

	10. * Overall satisfaction with this transaction
	Excellent Good Fair Poor 1 2 3 4

	11. * Overall satisfaction with Mid-State Truck
	Excellent Good Fair Poor 1 2 3 4

	12. * Based on this experience, would you recommend our company to a friend?
	YesNo If NO, why not?

	13. What can we do to serve you better?