Name:	Phone #:
Invoice #:	Email:

How did you hear about us?	What did you purchase?
Referral / Word of Mouth Billboard Newspaper Ad Internet / Website / Email	Parts Equipment Service Accessories

How satisfied were you with your product / service?	What could have made your purchase better?
Very Satisfied Satisfied Unsatisfied Very Unsatisfied

How many Acres do you maintain?	Is our facility Convenient, Clean, & Accessible?
Less than 1 1-3 3-5 6 and Over	Yes      No Comments

What equipment lines would you like to see us carry?	What can we do to Improve our Sales / Parts / Service?