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2. Customer Name
4. Customer Address
6. City
7. State
8. Zip Code
10. Reason for Visit

    Please select the reason for your visit to City Hall:

    1. Apply for Employment
    2. Inquire General Information
    3. Open Records
    4. Pay Utility Bill
    5. Question Regarding Utility Bill
    6. Start/Disconnect Service
12. Did the City Hall representative give you a proper greeting and felt welcomed?

    1. Yes
    2. No
14. About how long did you have to wait before speaking with a representative?

    1. I was taken care of immediately
    2. Within 3 minutes
    3. 3 to 5 minutes
    4. 5 to 10 minutes
    5. More than 10 minutes
16. Was the staff friendly and helpful during your visit?

    1. Yes
    2. No
18. Was the information provided by staff adequate and informative?

    1. Yes
    2. No
20. Did our representative:

    1. Quickly identify the problem
    2. Appear knowledgeable and competent
    3. Help you understand the cause and the solution to the issue
    4. Handle the issue with courtesy and professionalism

    Select all that apply

22. About how long did it take to resolve your problem if you had one?

    1. Immediate resolution
    2. Less than 10 minutes
    3. More than 15 minutes
24. Overall, how satisfied are you with the customer service experience?

    1. Very satisfied
    2. Somewhat satisfied
    3. Somewhat dissatisfied
    4. Very dissatisfied
26. Additional Comments
Leave This Blank:


28. 1. Receive an email copy of this form.
29. Email address

    This field is not part of the form submission.

30. Submit

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