CUSTOMER FEEDBACK

1. Your Account Information.
Your Business Name:		MID Number:	(begins with 628 or 415)
Your Name:		Install Date of Your Account:	Month January February March April May June July August September October November December Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Year 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Your Title:		Name of your EMG Rep:
Your Email Address:
Your City:

2. How did you hear about EMG?
	The EMG representative contacted me		Flier / Postcard / Mailer
	Referral / Networking Event		Trade Show / Business Expo / Chamber of Commerce
	Advertisement / Yellow Pages / Newspaper / Magazine		Radio / TV / Internet
	Other
3. Please check the things that helped you decide to do business with EMG?
	Receiving better customer service and support		Upgrading to better equipment and processing method
	The savings I will receive because of better rates and fees		Having a local representative and customer service
	My representative's sales presentation		Presentation of good sales materials
	EMG’s brand and reputation for providing good service		Quick turnaround time for getting setup
	Other
4. Please check the objections you had with doing business with EMG.
	Savings may not be worth the switch		Upsetting my relationship with my current provider
	Disruption of business and having to retrain my staff		Was not familiar with EMG
	Was not totally comfortable with Sales Representative		I have no objections to doing business with EMG
	Other
5. What did you like most about your Sales Representative?
	Overall presentation and expertise of EMG and service		Friendly attitude and positive demeanor
	Professional dress and impeccable grooming		Non-pressuring and helpful
	Other
6. Check all that apply about your Sales Representative and Sales Presentation.
	The rep was on time for our appointment		He/she was cordial and polite
	He/she was mindful of my time		The presentation material was excellent
	The presentation was informative and helpful		The presentation helped EMG win my business
	Other
7. Did you receive everything that was agreed upon from the sales presentation?
Yes No
8. Did you receive adequate equipment training and instructions on whom to call for assistance?
Yes No
9. Was the conversion of your account to EMG smooth?
Yes No
10. Please rate your overall satisfaction with EMG:
Very Satisfied
Satisfied
Not Satisfied
Comments:
11. What can we do better?