Mission Rubber Company
Customer Satisfaction Questionnaire

Please select the number that best describes your satisfaction with each of the items listed. Please comment on any rating of 3 or below.

5 = Extremely Satisfied
4 = Satisfied
3 = Not Quite Satisfied
2 = Dissatisfied
1 = Extremely Dissatisfied
NA = Not Applicable

Product

 Dissatisfied Extremely Satisfied
Quality 1 2 3 4 5 NA
Pricing 1 2 3 4 5 NA
Marking/Labeling 1 2 3 4 5 NA
Availability 1 2 3 4 5 NA
Comments:

Customer Service

 Dissatisfied Extremely Satisfied
Friendliness 1 2 3 4 5 NA
Order Accuracy 1 2 3 4 5 NA
Flexibility 1 2 3 4 5 NA
Responsiveness 1 2 3 4 5 NA
Product Knowledge 1 2 3 4 5 NA
Comments:

Shipping

 Dissatisfied Extremely Satisfied
On Time Delivery 1 2 3 4 5 NA
Packaging 1 2 3 4 5 NA
Claim Handling 1 2 3 4 5 NA
Comments:

Manufacturers Rep

 Dissatisfied Extremely Satisfied
Visits Often Enough 1 2 3 4 5 NA
Responsiveness 1 2 3 4 5 NA
Literature Updates 1 2 3 4 5 NA
Comments:

Overall Satisfaction

 1 2 3 4 5 NA
Company and Location
Name and Title
Telephone
Email
Would you like to be contacted regarding the above? Yes No