Name
Email address
Title
What operating
system are you running?
Windows XP
Windows NT
Windows 2000
Windows ME
Windows 98
Windows XP
Linux
Macintosh
Other
Internet Explorer
Netscape Navigator
Other
Industry
Please select one
Nuclear Power
Fossil Power
Oil & Gas
LNG
Petrochemical
Other
What type of
facility do you work in?
Nuclear Power
Plant
Fossil Power
Plant
Petrochemical
Processing Plant
Oil Refinery
Other
Size/output in
tons
Size/output in
megawatt
What industry
magazines do you regularly read?
What trade shows
do you regularly attend?
Do you want to
receive SOLUTIONS CCI’s customer newsletter?
What are your
favorite past times or hobbies?
Golfing
Hunting
Fishing
Sports
Traveling
Collecting
Electronics
Reading
Other
Do you influence
the buying decision at your facility?
Do you use the
Internet for information gathering / research?
What is your
primary source for learning about industry related
advances in technology?
What trade organizations
are you a member of?
How did you first
hear about CCI?
trade article
sales person visit
seminar
/ education training
word of mouth
competitor
web site / internet inquiry
directory listing
advertising
trade show
other
Over
the next several questions, rate your overall
experience with CCI
I always receive
excellent service from my CCI sales representative
I always receive
excellent service from CCI customer service
I always receive
excellent service from my CCI project manager
I always receive
excellent service from CCI field service
CCI always responds
to my inquiries within a reasonable amount of
time
CCI's Valve Doctors
always solve my problems the first time
CCI provides
its customers with the best solutions to control
valve problems in the industry
I am completely
satisfied with my CCI experience
Have you ever had a problem with a CCI valve?
If yes, please answer the question below. If
no, please skip the three questions.
Yes
No
CCI’s responded
to the problem within a reasonable amount of time
My CCI valve problem
was solved the first time
I am completely
satisfied that CCI can solve all my severe service
valve problems
Can potential
CCI customers call you as a reference?
Yes
No
Give a brief CCI
product / application / service testimonial.
Can CCI use quotes
from your testimonial in printed collateral and/or
sales presentations?
Yes
No
What is the highest
level of education you have completed?
high school graduate
some college
or technical school
college graduate
some graduate or
professional school
masters,
M.D., or doctorate
mechanical engineering
chemical engineering
structural engineering
other
What is your age?
20-29
30-39
40-49
50-59
60-69
70+
What is your approximate
yearly salary? (U.S. Dollars)
Under $20,000
$20-29,000
$30-39,000
$40-49,000
$50-59,000
$60-69,000
$70-79,000
$80-89,000
Over $90,000
decline to state
