Name
Address
Phone
E-mail

How did you hear about Expressions by Design?

Yellow Pages Referral Repeat Client Other:  

What type of product (s) did you select?

Were you presented with adequate sampling to help with your selection?

Yes No

Were your products delivered in a timely fashion?  Yes No

Did all representatives from Expressions by Design present themselves in a professional manner and pleasing to you?  Yes No

Were there any problems with any products you ordered and if so, were they resolved in an acceptable manner?  Yes No

Was the final job what you expected?  Yes No

Do we have your permission to use this information on our web site or in other promotional material?  Yes No

NOTE:  Your contact information will not be used in promotional materials or on our website.  Your name will be used only if you give permission to do so:
Do we have permission to use your name? Yes No
If so, how do you want your name shown, full name or initials:

Do we have your permission to use your contact information as a reference to other prospective clients?  Yes No

Is there any additional comments you would like to make about our service, products or representatives?