Customer Follow-Up Survey

Dear Valued Customer,

We would very much appreciate your feedback regarding your recent installation of water treatment equipment. Please take a few minutes to complete this form. Thank you in advance!

1.) Are you satisfied with your treated water?  Yes No


2.) Are you satisfied with the installation?  Yes No


3.) Was the operation and maintenance of your equipment explained to you so that you could understand it?  Yes No


4.) (For home-owned unit only) Have you received your service manual and warranty card?  Yes No

5.) Do you feel that you’ve made a wise investment in your water treatment system?  Yes No

6.) Would you refer De Anza Water Conditioning to your family, friends and neighbors?  Yes No

If so, please provide us with the names and phone #’s of potential customers and you will be rewarded with $50 for every referral that results in a sale!

Referral Name

Phone #

Referral Name

Phone #

7.) May we use your name for referral purposes in our literature,  Yes No

on our website,  Yes No

or over the phone?  Yes No

Customer signature to authorize this:


Customer name printed:

Preferred phone # to be given out over the phone:

Testimonial to be posted on our website:

Optional information:



Phone #:

*Please feel free to respond to the survey via email at customer@localhost.
Return address: 355 E McGlincy Ln, Suite H, Campbell, CA 95008. Thank you!