EmailMe Form - Customer Feedback & Satisfaction Survey

Date
MM / DD / YYYY
Name
Prefix First Last Suffix
Company
Job Title
Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Email
Would you like to receive TOA newsletters and product information?
YES
NO
Phone
### - ### - ####
Web Site
Markets Served (i.e-school, corporate, retail, etc…)
Type of Business
Reseller
Contractor
Consultant
Integrator
Design-Build
Which TOA product(s) do you currently sell/use and why?
For which applications do you use them?
What product(s) not currently offered should TOA introduce?
To which product(s) would you like to see added features? Which ones?
Which TOA product(s) would you like to learn more about?

How would you rate TOA in the following areas:

Questions/Comments:
Thank you for taking the time to provide us with your valuable feedback. Survey information will be kept completely confidential and will be used for internal marketing purposes only.

	Poor	Fair	Good	Very Good	Excellent
Build Quality and Reliability	1	2	3	4	5
Customer Service	1	2	3	4	5
Service & Technical Support	1	2	3	4	5
Features/Value	1	2	3	4	5
Technology & Innovation	1	2	3	4	5