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Customer Survey Form
Please fill out the form below and submit to United Electric Controls.

Required Fields *
Customer Information

  Full Name
  *

  Company Name
*

  Address 1
  *

  Address 2

  City
  *

  State
*

  Zip Code/Postal Code
 

  Country
*  

  Phone Number
  *

  Email Address

  Fax Number
  *

Please rate the subjects below with 1 being the lowest score and 5 the highest.

 
  

CATEGORY RATING ADD'L COMMENTS
1. Response to inquires/questions: 1 2 3 4 5
2. Factory Support: 1 2 3 4 5
3. Regional Manager Support: 1 2 3 4 5
4. Total cost for UE Products: 1 2 3 4 5
5. Delivery Performance: 1 2 3 4 5
6. Meet Customer Needs: 1 2 3 4 5
7. Quality of Workmanship: 1 2 3 4 5
8. Effectiveness of this Website: 1 2 3 4 5
9. Probability for Future Business: 1 2 3 4 5
10. Overall Evaluation: 1 2 3 4 5

Additional Comments or Suggestions:

Thank you for your time spent completing this survey.