'First Name', 'customer_name_last'=>'Last Name', 'address'=>'Address', 'city'=>'City', 'state'=>'State', 'zip'=>'Zip Code', 'phone'=>'Phone', 'cell_phone'=>'Cell Phone', 'office_number'=>'Office Phone Number', 'email'=>'Email Address', 'fax'=>'Fax Number', 'best_time_to_call'=>'Best time to call', 'describe_needs'=>'Description of Project', 'save'=>''); $output = ""; foreach($_POST as $field => $value) { if ($fields[$field] != '') $output .= ""; } $output .= "
".$fields[$field]."".$value."
"; #email process $MessageSent = mail($To, $Subject, $output, $Headers); if($MessageSent) { # header('Location: /services_ty.htm'); echo ''; exit; #echo "

We have successfully received your request.

"; #echo "A qualified representative will contact you to review your request..

"; } else{ echo "

The message was not sent successfully!

"; exit; } } ?>

Online Service Survey

Items marked with an (*) are required fields.

First Name* Last*
Address*
City* State*   Zip*
Phone* Cell
Office # Fax
E-mail*

Date of Service*   
What's your overall impression of our services? Great
 Good
 Poor
Rate your level of satisfaction with our customer service department. Great
 Good
 Poor
Was our service technician on time? Yes
 No
Were we accurately able to assess your need? Yes
 No
Rate the technician's product knowledge. Great
 Good
 Poor
Were you treated professionally? Yes
 No
Please rate the overall appearance of the technician. Great
 Good
 Poor
Would you select our service again? Yes
 No

Additional Comments:


Your comments will be reviewed by our management team in an effort to improve our service and are greatly appreciated.

Thank You!