Online Survey

Personal Information

First Name: *		Address:
Last Name: *		City:
Day Phone:		State:	Select AK AL AR AZ CA CO CT DE FL GA HA ID IL IN IO KA KY LO MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY
Evening Phone:		Zip:
E-Mail Address: *

Service Information

Vehicle Year		Work Order Number
Vehicle Make		Service Dates
Vehicle Model

Survey Questions

Please Rate our technicians.

1 Star: Poor, 2 Stars: Fair, 3 Stars: Good, 4 Stars: Excellent

Promptness *	0 1 2 3 4	Comment Box:
Professionalism *	0 1 2 3 4	Comment Box:
Courteous *	0 1 2 3 4	Comment Box:
Cheerful *	0 1 2 3 4	Comment Box:
Appearance *	0 1 2 3 4	Comment Box:
Quality of Work *	0 1 2 3 4	Comment Box:
Work Area Cleaned *	0 1 2 3 4	Comment Box:
Was your vehicle left clean and free of glass debris? *	0 1 2 3 4	Comment Box:

Please Rate our Office Team.

1 Star: Poor, 2 Stars: Fair, 3 Stars: Good, 4 Stars: Excellent

Professionalism *	0 1 2 3 4	Comment Box:
Courteous *	0 1 2 3 4	Comment Box:
Cheerful *	0 1 2 3 4	Comment Box:
Helpfulness *	0 1 2 3 4	Comment Box:
Informative *	0 1 2 3 4	Comment Box:
Knowledgeable *	0 1 2 3 4	Comment Box:

Would you recommend Hansen Auto Glass to Friends and Family? *

Yes No

Comment Box:

May we use your survey comments for future marketing needs. *

Yes No

• By clicking "Submit" you agree that HC Capital may process your data.