Example of Previous Survey

OMB number and expiration
date

U.S. Department of Commerce
Bureau of Export Administration
Customer Service Evaluation
Please Circle the Most Appropriate Response.

1. Overall, how satisfied were you with the quality of service you received from BXA on this occasion?
Very Satisfied

Somewhat Satisfied

Neutral Somewhat Dissatisfied

Very Dissatisfied

2. How satisfied were you with the following aspects of the service you received on this occasion?
a. Courtesy and friendliness:
Very Satisfied

Somewhat Satisfied

Neutral Somewhat Dissatisfied

Very Dissatisfied

b. Knowledge of the person you spoke with:
Very Satisfied

Somewhat Satisfied

Neutral Somewhat Dissatisfied

Very Dissatisfied

c. Effort made to understand your specific needs:
Very Satisfied

Somewhat Satisfied

Neutral Somewhat Dissatisfied

Very Dissatisfied

d. Timeliness of information sent to you:
Very Satisfied

Somewhat Satisfied

Neutral Somewhat Dissatisfied

Very Dissatisfied

e. Quality of written information provided:
Very Satisfied

Somewhat Satisfied

Neutral Somewhat Dissatisfied

Very Dissatisfied

3. The assistance provided on this occasion was instrumental in enabling you to:
a. Export your product in a more timely manner than would have been likely in the absence of help.
Fully Agree

Agree

Neutral

Disagree

Wholly Disagree

not sure

b. Export in full compliance with the Export Administration Regulations.
Fully Agree

Agree

Neutral

Disagree

Wholly Disagree

not sure

4. Have you received assistance or information from BXA in the past?
Frequently

Occasionally

Seldom Never

5. If we could change anything to serve you better, what would that be?
Thank you. You may mail your response using this form or fax to (714)660-9347.