Please provide the following contact information (please fill in what you can):

First Name
Last Name
Company Name
Invoice/Work-order #
Street Address
Address (cont.)
City	Ajax Markham Oshawa Toronto (GTA) Scarborough - -Select City- -
Province
Postal Code
Main Phone	(please include area code)
E-mail

Briefly describe what it is AMP Upholstery worked on for (or you what is was that you had purchased)?

Are you happy with the end-product that you received?

Yes No

The questions below will help us gain insight in the service we provide our clients

Are there any areas in which we could improve on?

Would you recommend AMP Upholstery to a friend or family member?

Yes No

May we use you as reference?

Yes No

Your endorsement of our service is very important to our success in the community!  Please let others know about the great service or product you received.

Lastly, how did you hear about AMP Upholstery?

Search Engine (i.e. Google) Internet Directory (i.e yellowpages.ca) Phone Book Word of Mouth Advertising sent to home Other - -Please Select- -

If you selected "Other", please explain further?

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