Customer Survey

SafeRide America Service Evaluation

Thank you for using our public service. Please share your feedback by filling in the information below. Feel free to use this form to praise or critique our programs. Our desire is to provide professional, reliable public services designed to pro-actively prevent all types of impaired driving. Your honest input will help make SafeRideAmerica better and is greatly appreciated.

Please share your contact information with us (Optional)

First Name

Last Name

Address 1

Address 2

City

State

Postal Code

Phone

Email Address

Would you like us to contact you about this via email or telephone?

Yes, email

Yes, phone

No you do not need to contact me

Use this area to make a general comment or statement about SafeRide America or one of its programs.

Tell us which service you would like to comment on.

SafeRide Service

SafeChauffeur Service

SafeParty Service

How long have you been using our service?

If commenting on a specific experience, tell us the date it took place.

If a reservation time was involved, tell us the time of the reservation here.

Did you make your reservation online or over the phone?

Online

Over the phone with

Please rate the following aspects of your experience with SafeRide America.

	Very Good	Good	Neutral	Bad	Very Bad	Not Applicable
Reservation Process
Overall Ease of Use
Price of Service
Drivers On Time
Driver Appearance
Skills of Driver
Quality of Service
Overall perception

What do you most like about our service?

What do you least like about our service?

Compared to other services of this type, how would you rate our service?

How likely are you to continue to use our service?

Would you recommend this service to others?

Yes

No

If your answer to the above question is "No", is there anything we can to do to fix this?

May we publish your comments submitted on this form on our web site or promotional liturature?

Yes

No

May we publish all or part of your name in conjunction with your comments?

Yes, publish my full name (Ex: Mary Jones)

Yes, publish first name, last initial (Mary J.)

Yes, publish first initial, last name (M. Jones)

Yes, initials only (M.J.)

No, please do not publish my name

Indicates Response Required