Customer Retention Loyalty Questionnaire

June 7, 2011

 

Customer’s name: _________________________

Address (optional): _________________________

Date: ______________________________________

Please confirm whether or not you have stopped using the company’s services:

Yes: _______________

No: ___________

Please indicate the duration spent using the company’s services:

___________________

Please indicate when you stopped using the company’s services:

______Please indicate details about the person you informed about your cancellation:

Name: ___________________________

Position: __________________Date: _________________________

Please indicate the method you used to inform them about your cancellation:

Telephone: _______________________

Email: __________________________Letter: _______________________________

Other (please specify): _____________________________________________________

Please describe the reasons that forced you to terminate the company’s services:

_______________

Please describe reasons that would have ensured your continued use of the company’s services:

________________________________

Please indicate whether you hired a new company to provide you with similar services (Yes or No):

__________________________

Please indicate whether you are satisfied with the new company’s services (Yes or No):

________________

Please give any additional comments:

______________________________

Download Customer Retention Loyalty Questionnaire in Word Format

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