Hagan Appliance

Service Feedback

Please let us know how we did.

Customer Information

Name:  
Address:  
City:  
State:
Zip Code:   
Primary Phone:
(123) 456-7890  
Alternate Phone:
(123) 456-7890 
E-mail:
address@domain.com  

Appliance Information

Type:  
Make:
Original Problem:  

Service Call Information

Service Date:
mm/dd/yyyy   
 
Service Time:
hh:mm AM/PM   
 
Service Ticket #:    
Results: Did the service call result in resolution of the original problem?
  Did the technician discover any other issues?
  Number of trips needed to resolve the original problem?

Technician Information

Serviceman:  
On a scale of one to five (with 1 being the worst and five being the best) rate the technician who serviced your appliance on the following factors:
  Did the technician seem knowledgeable?
  Was the technician clean?
  Was the technician polite and courteous?
  Did the technician clean up after himself?

Additional Information

Marketing: How did you hear about Hagan Appliance?
Comments:  


Copyright © 2011 Hagan Appliance Service, Inc.
807 Oak Hill Road | Evansville | IN 47711-5397 | (812) 423-6494