CUSTOMER:_______________________________________

CONTACT:__________________________________________ Date:____________

Overall, how would you rate your experience dealing with us?

VERY SATISFIED

COMPLETELY SATISFIED

SATISFIED

UNSATISFIED

Comments:

On a scale of 1 to 10, where 1 indicates unsatisfied and 10 indicates completely satisfied,

How satisfied were you with the timeliness of delivery of our products ?      

1 2 3 4 5 6 7 8 9 1 0

Comments:

How satisfied were you with the quality of the product provided?

1 2 3 4 5 6 7 8 9 1 0

Comments:

Overall, how satisfied were you with our pricing?

1 2 3 4 5 6 7 8 9 1 0

Comments:

Is there anything that we at Peterson Instruments Services Ltd. can do to improve our service for you?

Thank you, PLEASE FAX COMPLETED SURVEY TO:

Gary Peterson, President, 403.291.0960

Peterson Instruments Services Ltd.