United Gear & Assembly, Inc

Customer Satisfaction Survey
*Customer Name
*Contact Person		Email
City	State Zip

* Required Fields

Please rate your satisfaction with United Gear on the following:

	Excellent	Very Good	Good	Satisfactory	Poor
Quality of Product	1	2	3	4	5
On-Time Delivery	1	2	3	4	5
Customer Service	1	2	3	4	5
Administrative Order / Invoice Accuracy	1	2	3	4	5
Overall Satisfaction	1	2	3	4	5

Additional Comments/Suggestions
Please include any additional information related to making United Gears products and service better.

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