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Name of Business:
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Name of person(s) you with:
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Services and/or products requested:
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Please rate your overall experience with this business (1=Very Bad and 5=Very Good):
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Please rate the quality of services/products (1=Very Bad and 5=Very Good):
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Please rate the affordability of services/products (1=Very Bad and 5=Very Good):
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Please rate the quality of customer service (1=Very Bad and 5=Very Good):
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Please rate the timeliness of service provided (1=Very Bad and 5=Very Good):
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