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Customer Feedback Form

* denotes a required field

Driver's Name* Vehicle Registration Number Your Name Contact Number Email Address Date*

For each item identified below, select the number to the right that best fits your judgement of its quality. Use the rating scale to select the quality number.

Survey Item	Scale
Survey Item	P o o r	Good			E x c e l l e n t
1. Was the driver on time*	1	2	3	4	5
2. Was the driver in uniform*	1	2	3	4	5
3. Cleanliness of the vehicle*	1	2	3	4	5
4. Courtesy of the driver*	1	2	3	4	5
5. Communication skills*	1	2	3	4	5
6. Driver's driving skills*	1	2	3	4	5

Additional Comments 9 + 5 = ? *

Eslum Cabs

P O Box 12345 67890
Nairobi
Kenya

Landline: 0123 456789
0123 456789

Mobile: 0123 456789
0123 456789

Email: eslum@example.com

Copyright © 2015 Eslum Limited

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