Brand Image Questionnaire

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|Customer Name : | | | |
|Address : | | | |
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| | |Telephone : | |
|Contact Name : | |Position : | |
|Product Codes : | | | |

Thank you for your agreement to help xxx in their efforts to understand their customer’s perceptions of them. The responses to this questionnaire are intended to provide focus and impetus to xxx's improvement programme and will used solely for this purpose, as such we hope that you will benefit from a service which better meets your current and future needs. Your reply will be treated in confidence.

|Notes to assist in completing the questionnaire: |
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