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Customer Feedback Form
Customer Feedback Form
Date Submitted:
What is your reason for contacting us? (check all that apply)
General Information
Insurance Products
Payroll Products
Problem Resolution
Technical Assistance
Other:
How many times have you had contact with our staff in the last 12 months?
0
1
2-5
6+
How long have you interacted with our company?
Less than 1 year
1-5 years
5 or more years
Please indicate the name(s) of any staff person whom you had contact with:
I was satisfied with my salesperson's knowledge of products and recommendations for coverage:
Agree
Disagree
N/A
My experience with the staff was courteous and professional:
Agree
Disagree
N/A
My experience with the staff was knowledgeable and helpful:
Agree
Disagree
N/A
I received a timely response to my inquiry:
Agree
Disagree
N/A
Any applications and instructions I have received are easy to understand and straightforward:
Agree
Disagree
N/A
My overall experience with AMIS is outstanding:
Agree
Disagree
N/A
The website is easy to use, well organized and has accurate information:
Agree
Disagree
N/A
The client software is easy to use and is well organized:
Agree
Disagree
N/A
We offer training in the following areas. Tell us which topic(s) you would like to hear about:
Workers' Compensation Claim Management
Human Resource Management
Safety Compliance / Injury Prevention
How to Market Your Company
How to do Budgeting in Excel
Other:
Please add any comments or suggestions you may have regarding our staff, website or client software. If we did not meet your expectations, please tell us about it. If applicable, please include the staff members name and date of the incident:
Contact Info (optional):
Name:
Company Name:
Email:
Daytime Phone:
*
Security Code:
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406 Sunrise Avenue, Suite 310 ~ Roseville, CA 95661