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Customer Survey

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Customer Information

First Name:  *  
Last Name:  *  
Street Address:
City:
State:
Zip:
Email:  *
Email Confirmation:  *

Service Information

Service:  *
Date of Service:  *
Tire Size:
Engine Size:
Vehicle:
Year
Make
Model
Option
   
Invoice #:

Location Information *







Rating Information *

 
Exceptional Satisfactory Needs Improvement
Housekeeping: 
Employee Attitude: 
Employee Knowledge: 
Quality of Service: 
Overall Value: 
Overall Rating: 


 
Yes No
Will you return for tires? 
Will you return for mechanical service? 
Warranties explained thoroughly? 
Was your quote accurate? 
Was work completed on time? 
Would you recommend us? 
 
How did you choose Tireman?  *

Where can we improve?
 
 
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