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Service Feedback
Please let us know how we did.
Customer Information
Name:
Address:
City:
State:
Indiana
Kentucky
Zip Code:
Primary Phone:
(123) 456-7890
Alternate Phone:
(123) 456-7890
E-mail:
address@domain.com
Appliance Information
Type:
Please Make a Selection
Dishwasher
Washer
Dryer
Range
Oven
Refrigerator
Other
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?
Yes
No
Did the technician discover any other issues?
Yes
No
Number of trips needed to resolve the original problem?
Technician Information
Serviceman:
Mike
Russ
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?
1
2
3
4
5
Was the technician clean?
1
2
3
4
5
Was the technician polite and courteous?
1
2
3
4
5
Did the technician clean up after himself?
1
2
3
4
5
Additional Information
Marketing:
How did you hear about Hagan Appliance?
Factory
Family
Friend
Phone Book
Internet
Store Referral
Other
Comments:
Copyright © 2011 Hagan Appliance Service, Inc.
807 Oak Hill Road | Evansville | IN 47711-5397 | (812) 423-6494