1) Please provide the following information below:
a) Name
b) E-mail
c) Location of Service
<-- Choose One --> Clarksville, MD Columbia, MD Gaithersburg, MD
d) Date of service
<-- Choose Month --> January Februrary March April May June July August September October November December    <--Choose Day --> 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31    <-- Choose Year --> 2007 2008 2009 2010 2011 2012 2013
e) Service Order #
2) Has a staff member spoken to you about the HCA Total Lifetime Care program TLC?
Yes No
3) How would you rate the quality and value of the services or repairs completed?
Excellent Average Good Fair Poor
4) How would you rate the Communication of the service and repairs needed?
Excellent Average Good Fair Poor
5) Were our staff members courteous,efficient,and knowledgeable?
Yes No
6) Do you feel that you have full understanding of the service, and repairs needed?
Yes No
7) Please provide additional comments with name and or Repair Order number.
9) How would you rate your interaction with your service advisor?
Excellent Average Fair Poor
10) Please provide us with your views reguarding our quality and workmanship
11) Do you feel that you received value for your services?
Yes No
12) How did you first learn about Hillmuth Certified Automotive?
Friend Mail Internet Business referral Radio/TV Yellow Pages Coupon Book Newspaper Location
13) If you are not enrolled in the HCA Total Lifetime Care program, Would you like information? Please Provide Name, and Contact Preference.
14) Are you aware that Hillmuth Automotive offers a 90 Day Deferred Payments on all Repairs and Services over $150.00
Yes No
15) Would you like to be notified by telephone for future services/repairs from your service consultant?
Yes No
16) Did you know Hillmuth Automotive is a Family owned and operated repair facility since 1978?
Yes No
Thank you for taking the time to help us improve the services HCA offers. We look forward to serving you soon.