Name:

Current Address:



City: State: Select AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY

Email:

Phone: Ext:


Move Date: (mm/dd/yy)

Crew Chief:

Crew Members:


1. How did you hear about Amazing Moves?
Repeat Customer Friend/Relative   Real Estate Agent

Other:

2. How would you rate Amazing Moves in the following catagories?

Initial Contact: (1-Poor 10-Excellent)

Crew: (1-Poor 10-Excellent)

Overall: (1-Poor 10-Excellent)

3. What most pleased you with Amazing Moves?

4. Would you use Amazing Moves again? Yes No

5. May we use you as a reference? Yes No

6. Any Additional Comments: