Gas and Supply

On a zero to ten scale, how likely is it that you would recommend us to a friend or colleague?


0	2	4		6	8	10
Not Likely			Very Likely

What is the primary reason for your score?

The following information is optional but extremely helpful and greatly appreciated. If you would like a response please fill in either the phone number or email address below.

Name


First	Last

Customer ID
This is a 5 digit number which appears on Gas and Supply invoices and PODs.

Serving Branch

Email Address

Phone Number

What is your preferred method of contact?

Email Phone

How did you learn about this survey?

Was your comment/score in reference to an order or invoice? If so please enter the order/invoice number below.

What type of account do you have with us?

Personal Corporate

Corporate Info

Company Name

Your Primary Position

Location Address




City	State	Zip