INTERNAL CUSTOMER SURVEY INFORMATION FORM

Congratulations on your commitment to providing the best internal customer service!   To prepare your internal customer survey, we need to ask you a few questions about your company.  We also would like your opinion on where your department stands in terms of internal customer service.  (You might want to print this page to compare your expectations with your final results.)

Contact Information (*Required fields)

Name*

Title*

Department name (as it will appear in the survey and report)*

Company name (as it will appear in the survey and report)*

Address 1*

Address 2

City*

State*

ZIP*

Telephone*

Email*

Billing Information

The cost of the survey is $900 and includes the on-line survey personalized with your company name and department name, unlimited survey responses, plus an overall report with comparisons to the proprietary Metrus database.  You may also select the following options:

Analysis by key stakeholder group: Senior leaders (VP and above), Directors/Department managers, Supervisors, and Staff.  Choose this option if you believe different stakeholders may have different needs and expectations of your department.  Cost: $300.

Analysis by functional area of respondent: Communications/Public Affairs, Customer Service, Finance/Accounting Services, Human Resources, Information Technology, Legal, Manufacturing/Production/Operations, Marketing, Procurement/Purchasing, Quality, Research & Development, Sales, Security, Other (Nursing, Lab, Food Services,etc. for healthcare organizations).  Choose this option if you believe different departments may have different perceptions of your internal service.  Cost: $300

Customize your survey: Modify or delete questions, or add up to five (5) custom questions. (You must choose this option in order to make any modifications to survey content.) Cost: $2,500

Interested in more extensive customization? Call us.

	please invoice me
	I want to pay by credit card (A representative will call you.)

Company information

Annual revenues

	Is your company public?
	Yes
	No

(if yes) Stock symbol

Compared to other organizations in your industry, how does your company rank in:
	Top Third	Middle Third	Bottom Third	Don't Know
Financial performance?
Productivity?
Customer satisfaction?
Employee retention?

How many employees are in your entire company?

What is your company's primary industry?* --Click Here-- Advertising Aerospace Biotechnology Chemical Computer Construction Consulting Consumer Products Defense Education and Training Engineering Entertainment and Sports Environmental Financial Services Food and Beverage Manufacturing Government Health Care Services Heating, Air Conditioning, Plumbing Hospitals Information Insurance Internet Services Manufacturing and Industrial Products Oil, Petroleum and Plastics Pharmaceuticals/Medical Devices Professional Services Real Estate Retail and Restaurants Software Telecommunications Textiles and Apparel Tourism, Hospitality and Travel Transportation and Automotive Utilities and Energy Other - Not Listed Here

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Thinking about your own department:
1. What rating do you expect your internal customers to give your department on its overall service quality?	Very Good		Good		Average		Poor		Very Poor

	Strongly Agree	Agree	Neither Agree Nor Disagree	Disagree	Strongly Disagree	Don't Know
2. Employees in my department recognize and support the need for continuous improvement in internal customer service.
3. Performance standards for service to internal customers have been established in my department.
4. My department has been effective in taking action and improving service where needs have been identified.
5. Overall, the goals of my department are aligned with the company's business strategy.
6. Overall, my department has the capabilities (talent, information and resources) to execute our business strategy.
7. Employees in my department would recommend this company as a place to work.

Think about your company or organization as a whole and indicate your degree of agreement with the following statements:

8. Internal customer service is important to our company's business success.
9. Top leadership of our company is committed to superior quality in deeds as well as words.