Survey : Questions

In these difficult economic times American Independent, Inc. is seeking to broaden its customer base to encompass a greater national and international area. As we try to accomplish this, we know its also very important to ensure that we have complete satisfaction amongst our current customers. Please fill out this short survey to give us an idea of where we stand, and where we need to stand, in order to compete in this ever-changing industry and to continue to improve the relationships we maintain with our repeat customers. Upon completing this survey, American Independent, Inc. will reward you with a $500 credit towards your next purchase of $5000 or more.

1.

How do we rate on the following attributes?

	Poor	Fair	Average	Good	Excellent
Quality of our products
Price/value of products
Customer service experience
Professionalism
Understanding customers' needs

Comment:
500 character(s) left.

2.

How do you rate us in comparison to other companies offering the same services?

Much higher

Somewhat higher

Same

Somewhat lower

Much lower

Don't know

3.

How likely are you to continue using our services?

Very likely

Somewhat likely

Neutral

Somewhat unlikely

Very unlikely

4.	In which areas would you like to see improvement?
	500 character(s) left.

	In an effort to establish some credibility on a national and international level, we are hoping to get some real feedback from our customers to post on our website. Please be as articulate as possible with the following answer. We will contact you for your permission prior to posting any references to you or your company on our website.

5.	If you were to recommend American Independent, Inc. to a friend, what would you say?
	500 character(s) left.

6.

To receive your $500 credit towards a future purchase of $5000 or more, we need you to verify your personal information.

First Name:
Last Name:
Company Name:
Work Phone:
Email Address:	emailaddress@xyz.com
Address 1:
Address 2:
City:
State/Province (US/Canada):
Postal Code: