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		Workorder#:
		Date:
Billboard Friend Family Member Drove By Return Customer Dex On-line Church of Assumption	St. Richard's All Saints Verizon-Edina Verizon-IGH Verizon-Richfield Verizon-Eden Prairie Verizon-Bloomington	Qwest Dex-St. Paul Qwest Dex-Mpls.(Yellow) Qwest Dex-South of the River Qwest Dex-Mpls.(White) Village Profile-Directory Yellow Book-Mpls/St.Paul Yellow Book-South Metro
Referred by:              Other:
Radio:                (Please name radio station)     Where did you find our number?        Were you satisfied with our explanation for the problems & our efforts to  repair      them?...........................................................................................  Yes      No     Were you satisfied with the length of time it took to complete the work done to     your vehicle?...............................................................................  Yes      No     Was your vehicle ready when promised?...................................  Yes      No     Would you return to us for future service?..............................   Yes      No     Would you recommend us to a friend or family     member?......................................................................................  Yes     No     Were you treated with courtesy & respect by our staff?..........   Yes     No     Were you satisfied with the cleanliness of your vehicle upon it's     return?........................................................................................   Yes     No     Overall, how would you rate your experience with us?   Very Satisfied  Satisfied  Ok  Dissatisfied  Very Dissatisfied     Was there anything we could have done to better your service? If so what? Image Validation: Please enter the characters in the image to the right. All letters are lowercase. Characters: