Customer Feedback Form
CNG
Domestic
Commercial
Industrial
Consumer Number (CRN)
*
:
Customer Name :
Customer Phone
*
:
State
*
:
Select State
Andhra Pradesh
Karnataka
Madhya Pradesh
Maharashtra
Odisha
Punjab
Rajasthan
Tamil Nadu
Telangana
Uttar Pradesh
Geo Areas
*
:
Select GA
District
*
:
Select District
Locations
*
:
Select Location
Customer Address :
Suggestion
Compliment
Complaint
S.No.
Evaluation of performance
Not Satisfied
( 1 )
Satisfied
( 2 )
Fairly Satisfied
( 3 )
Highly Satisfied
( 4 )
Excellent
( 5 )
1
"Delivery" Meeting the required Quantity
2
"Delivery" Quality of Product
3
"Delivery" Quality of Services
4
Required Parameters: Pressure/ Temperature
5
Safety Practices
6
Environmental Aspect
7
Response to concern/complaint raised
8
Value for money
9
Behavior/Conduct of Staff
10
Overall Service
11
On a scale of 1 – 5, how likely would you recommend our products and services to others?
Customer’s Remarks :
Maximum 225 characters Allowed