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First Name
Last Name
Address
City
State
ZipCode
Phone
Your Email
Your Install Date	(mm/dd/yyyy)
Serial Number
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How did you find us?

Bison	Franchise Gator	Another Franchise Portal
entrepreneur.com	Inc. Magazine	Entrepreneur Magazine
Fast Company Magazine	Yellow Pages	Google
Yahoo!	MSN	RSVP Mailing
Postcard	Magazine Ad	Friend
Another Website	Home Show	Door Hanger
Letter	NiteLites’ Van	Newspaper Ad
Oversized Postcard

Your Impression of our Products/Services As a valued customer of NiteLites, we would greatly appreciate just a few minutes of your time so that you can tell us about your experience with our company. This information will be passed onto our corporate headquarters as we continually strive to improve our products and services. We could potentially use your feedback in future advertisements or literature. Please indicate if you prefer that we not use your name. Please rank your survey answers according to the following: 1 - Least Satisfied; 2 - Somewhat Satisfied; 3 - Satisfied; 4 - Very Satisfied; 5 - Most Satisfied
1. What was your initial impression of NiteLites’ professionalism?	1 2 3 4 5
2. How do you rate the communication between you and your NiteLites’ professional?	1 2 3 4 5
3. How informative was the free demo process?	1 2 3 4 5
4. How well did we explain how to use your system after installation?	1 2 3 4 5
5. How would you rate the overall quality of the NiteLites’ products?	1 2 3 4 5
6. Please rate your over all satisfaction dealing with NiteLites.	1 2 3 4 5
Your Impression of the NiteLites' Representative/Crew Please rank your survey answers according to the following: 1 - No; 2 - Not Really; 3 - Sort Of; 4 - Yes; 5 - Absolutely
7. Would you recommend the NiteLites’ system to a friend or family member?	1 2 3 4 5
8. The NiteLites’ professionals were courteous.	1 2 3 4 5
9. The NiteLites’ professionals were knowledgeable.	1 2 3 4 5
10. The NiteLites’ professionals arrived on time.	1 2 3 4 5
11. The NiteLites’ professionals explained the installation process thoroughly.	1 2 3 4 5
12. The NiteLites’ professionals educated me on the use of the system.	1 2 3 4 5
13. Did you sign up for the NiteLites’ MVP (Maintenance Value Program)?	Yes No
14. May we use your name and/or any comments you may have on our website or printed material?	Yes No
15. In what ways can we improve to better serve you?
16. Please tell us of your overall experience with NiteLites:

Your referrals are truly appreciated/rewarded Who do you know who might be interested in additional information about NiteLites? If your referral purchases a NiteLites’ system, you will be rewarded.
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