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Business Name ( You Like to Review) *

Business Address *

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How satisfied are you with the reviewed business/services? *

	Very Unsatisfied	Unsatisfied	Neutral	Satisfied	Very Satisfied
Products/Services	Products/Services Very Unsatisfied	Products/Services Unsatisfied	Products/Services Neutral	Products/Services Satisfied	Products/Services Very Satisfied
Customer Interaction	Customer Interaction Very Unsatisfied	Customer Interaction Unsatisfied	Customer Interaction Neutral	Customer Interaction Satisfied	Customer Interaction Very Satisfied
Transaction	Transaction Very Unsatisfied	Transaction Unsatisfied	Transaction Neutral	Transaction Satisfied	Transaction Very Satisfied
Location & Business Appearance	Location & Business Appearance Very Unsatisfied	Location & Business Appearance Unsatisfied	Location & Business Appearance Neutral	Location & Business Appearance Satisfied	Location & Business Appearance Very Satisfied
Service Delivery	Service Delivery Very Unsatisfied	Service Delivery Unsatisfied	Service Delivery Neutral	Service Delivery Satisfied	Service Delivery Very Satisfied
Follow Up	Follow Up Very Unsatisfied	Follow Up Unsatisfied	Follow Up Neutral	Follow Up Satisfied	Follow Up Very Satisfied
Overall Experience	Overall Experience Very Unsatisfied	Overall Experience Unsatisfied	Overall Experience Neutral	Overall Experience Satisfied	Overall Experience Very Satisfied

How likely are you to *

	Very Unlikely	Unlikely	Neutral	Likely	Very Likely
Buy/Visit again	Buy/Visit again Very Unlikely	Buy/Visit again Unlikely	Buy/Visit again Neutral	Buy/Visit again Likely	Buy/Visit again Very Likely
Recommend product to others	Recommend product to others Very Unlikely	Recommend product to others Unlikely	Recommend product to others Neutral	Recommend product to others Likely	Recommend product to others Very Likely
Recommend business/services to others	Recommend business/services to others Very Unlikely	Recommend business/services to others Unlikely	Recommend business/services to others Neutral	Recommend business/services to others Likely	Recommend business/services to others Very Likely

Your Overall Rating *

Overall, how would you rate your experience with the reviewed business or services ?

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What did you like most about the business/service ? *

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