Count ON Us Customer Service Feedback Form

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Please correct the field(s) marked in red below:

Complete this form to help us identify ways we can strengthen customer service; and recognize employees who go above and beyond in providing exceptional customer service.

Your feedback is very important to us.  Thank you for your time.

1
 Date of Visit:
2
How satisfied were you with the service you received?
How satisfied were you with the service you received?
3
To nominate a town employee for a customer service award please tell us the employee's name:
4
Why do you feel the employee's customer service went above and beyond expectations?
5
May we contact you?
May we contact you?
6
Contact Information:
Contact Information:
  1. To receive a copy of your submission, please fill out your email address below and submit.