The following survey is one of many efforts at Electro-Kinetics to improve the overall customer experience. We are dedicated to providing the highest level of customer service and appreciate your feedback. If you have any further comments or suggestions, please contact us anytime. Thank you.

Name
Company
Phone
Fax
E-mail

How did you hear about us? (i.e., referral, trade publication, search engine, yellow pages, salesperson)
Please describe your applications.
Have you purchased from Electro-Kinetics in the past?
Yes No (If No, skip to question 5)
How would you rate your overall experience?
Choose... Excellent Very Good Fair Poor
Please detail reasons for rating.
How can we improve the purchase experience?
What factors influence purchase decisions for your applications?
Service Selection Item in Stock Price	Salesperson Particular Mfg. Other
If Other, please specify
What additional features would you like to see on www.e-kinetics.com?
Where do you access the internet?   Choose... Home Work Both   Approximately how much of your workday is spent on the internet?   Choose... less than 30 min 30-60 min 60-90 min 90-120 min Over 120 min   What is your connection speed?   Choose ... 14.4k modem 28.8 modem 38.6 modem 56k modem T1 or ISDN Cable modem Not sure   Preferred method of correspondence:   Choose... Phone Fax E-Mail No preference
Additional comments and suggestions: