Sample Style 1
  Customer Satisfaction Survey
  www.moderntechnology.com
 

 

 

 

 

 



Please fill out this survey in order to participate in the CHECKBOX Survey Server Beta Program.


 
Contact Information
 
*1.  Your name:
 
*2.  Title:
 
*3.  Work email address:
 
4.  Geographic Region
(if global company, choose headquarters location):



 



Business/Industry Related Information
 

 
5.  Which of the following best describes your business or industry:
 
6.  If "other" please specify:
 
*7.  Number of employees at your company:
 
*8.  Number of desktops at your company:
 
*9.  Number of laptops at your company:
 
*10.  Number of servers at your company:
 
  


Directions

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