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Customer Service Satisfaction Survey

Date of Your Visit (mm/dd/yyyy) :
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Department Visited :
Employee who assisted you (if known):
Permit Number (if you received a permit) :
Complaint Number (if provided) :
Name (optional):
Address (optional) :
Phone Number (optional) :
Email Address (optional) :

Please rate our service by selecting an option for each category below :

Courtesy : Excellent Good Fair Poor
Promptness : Excellent Good Fair Poor
Professional Manner : Excellent Good Fair Poor
Level of Knowledge : Excellent Good Fair Poor
Overall Service : Excellent Good Fair Poor

Other Comments or Suggestions :