CEI Customer Survey

Please fill out this short form to let us know how we are doing.

What was the date of your purchase? / MM / DD YYYY
Model and S/N of chair if available.
Was the chair purchased by a facility or a family member? Family Facility
Please let us know the name of your sales representative, if known.
Was the chair a proper fit? Yes No
If no, please let us know why or if there were extenuating circumstances that prevented a proper fit.

Please be as thorough as possible in your description.
Are you satisfied with the purchase? Yes No
How would you rate your experience with Cherubini Enterprises, Inc; 1 being poor to 10 being excellent
Is there anything we could have done to improve our service?

Your opinion is very important to us, we want to do our best.
Name First Last
Address
Street Address

Address Line 2

City

State

Postal / Zip Code
Phone - (###) - ### ####
Email