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Cleanliness:  Please Select Very Poor Poor Fair Good Very Good

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Phone Representative Was : Please Select Pleasant Courteous Discourteous

Service Performed Was:  Please Select Very Poor Poor Fair Good Very Good

Technician's Appearance:  Please Select Very Poor Poor Fair Good Very Good

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Did the Technician Complete "Peace of Mind" Inspection?  Please Select Yes No

Were you offered Home Protection Membership?  Please Select Yes No

Were you offered a 5 year extended guarantee?  Please Select Yes No

Would You Use Us Again?  Please Select Yes Maybe No

How did you hear about us?  Please Select Yellow Pages Newspaper Ad Repeat Customer Radio Ad TV Ad Refferal Coupon From Refrigerator Magnet Saw Our Truck

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