Format No: Rev.

:
ZIRCAR REFRACTORIES LTD. F/MKT/06 01
Page #:
Customer Feedback Form 1 of 1 01/01/2019

To be filled by marketing personnel before sending: Year- Date:

1. Name and address of the Customer

2. Phone no._________________________ Fax no._______________

3. Name and designation of the contact person:
4. Since how long with us as a dealer?
 To be filled by the customer: (remark with specific case is appreciated-specially while rating in 5 or 1.)
 If required use Separate sheet for brief description indicating Section & Point number
(A) PRODUCT QUALITY: (in line with contractual agreement)
Criteria Best 5 4 3 2 1 Worst Remark

1. Product dimension quality

2. Consistency of product quality
3. Finishing / Appearance / Aesthetic
4. Fitment in use
5. Packaging
6. Material quality of Product
7. Life of product
8. As compared to competitors,
(B) DOCUMENT QUALITY
1 Offer/ Order Acknowledgement
2. Invoice & Delivery Challan / Excise
Gate Pass
(C) SERVICE QUALITY
1. Response time for the queries raised,
2. Time commitment for delivery,
3. Problem resolution quality,

(D) OVERALL PERFORMANCE OF THE ORGANISATION:

With reference to product, service & cost

(E) YOUR SUGGESTIONS REGARDING:

1. Product delivery time:
2. Documentation:
THANKS A LOT
 if more than 5 products is being purchased by party, attach separate sheet listing all the products
 Please arrange to return this form at your earliest duly filled.

Stamp & signature of customer

Or it’s representative