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Customer Company Name:  

Customer Contact:           




In our continuing efforts to improve our quality system, we would ask you to complete this Customer Survey Form and send it back via Fax or Mail it back to us, within one week of Receipt. Your input will assist us significantly in further improving our product quality and responsiveness to your requirements.

Please check the appropriate number, with “5” indicating “Very Pleased” and “1” indicating “Very Displeased”

1. Overall quality product provided.   1   2 3 4 5
2. ON-Time delivery. 1 2 3 4 5
3. Management and Communication Expertise. 1 2 3 4 5
4. EMA handling of quality issues. 1 2 3 4 5
5. Overall Performance 1 2 3 4 5

We would appreciate any comments you would care to make elaborating on any of the survey items listed above or on any topic you may feel we have omitted.


We would also appreciate any suggestion you may care to give us concerning improvements in any area of our business with you. We value your comments in this important area very highly since we are in business to provide the highest level of quality to our customers.



EMA Customer Survey Form