Customer Name
Email
Address
City
State		--Select-- Outside US Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Washington D.C. West Virginia Wisconsin Wyoming --Other US-- American Samoa Federated States Of Micronesia Guam Marshall Islands Northern Mariana Islands Palau Puerto Rico US Virgin Islands --US Military-- Armed Forces Africa Armed Forces Americas Armed Forces Canada Armed Forces Europe Armed Forces Middle East Armed Forces Pacific
Zip
Date Job Completed		--Month-- January February March April May June July August September October November December --Day-- 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 --Year-- 2005 2004 2003 2002 2001 2000
Business Manager
Job Site Manager
Final Contract Price		$
Rate the Manager
Returned call within 48 hours		Yes No
Did estimate when promised		Yes No
Did job when promised		Yes No
Polite and courteous at all times		Yes No
Rate the Painters
Courteous workers		Yes No
Hard working		Yes No
Job site neat		Yes No
Attention to detail		Yes No
Clean-up at job completion		Yes No
How do you feel about the paint job?
Extremely Pleased 5/5 Rating		5 Stars
Pleased 4/5 Rating		4 Stars
Satisfied 3/5 Rating		3 Stars
Not Satisfied 2/5 Rating		2 Stars
Extremely Unhappy 1/5 Rating		1 Star
Would you use American Painting Company again?		Yes No
Additional Comments
I have read and understand the American Painting Company 2 Year Warranty		Yes No