Complete this form to help us identify ways we can strengthen customer service; and recognize employees who go above and beyond in providing exceptional customer service.

Your feedback is very important to us.  Thank you for your time.

1

 Date of Visit:

Date of Visit:

2

How satisfied were you with the service you received?

How satisfied were you with the service you received?

Very Satisfied	Satisfied
Dissatisfied	Very Dissatisfied

3

To nominate a town employee for a customer service award please tell us the employee's name:

To nominate a town employee for a customer service award please tell us the employee's name:

4

Why do you feel the employee's customer service went above and beyond expectations?

Why do you feel the employee's customer service went above and beyond expectations?

5

May we contact you?

May we contact you?

Yes

No

6

Contact Information:

Contact Information:

Name	Address
Phone	Email

1. To receive a copy of your submission, please fill out your email address below and submit.
2. Email Address

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