Dear Valued Customer,

Manrex Limited would like to take this opportunity to say, "Thank you for your order," and to ask you how we did. Please take a moment to fill out our short survey for a chance to win a $100.00 Pizza Gift Card to a local restaurant of your choice! Either way, we want to hear from you. You will automatically receive a $20.00 Manrex Voucher*, to be used towards future Manrex purchases, for completing our survey and assisting us in improving our products and services.

Customer Name:
Contact Name:
Customer #:
Telephone:	( ) -
Email Address:

Please indicate your rating by choosing Satisfied or Dissatisfied.

A. How satisfied are you with Manrex products and services?
	Satisfied	Dissatisfied
Value for price
Quality
Delivery time of shipments
Orders filled correctly
Variety of products offered
Effectiveness and efficiency of our Medication Delivery Systems (Blister and Card System)
Products meeting needs
B. How satisfied are you with Manrex?
	Satisfied	Dissatisfied
Purchase experience
After-sale support
Courteous/friendly/helpful Staff
If you had a complaint, was it resolved?
Customer Service Order Follow up Program
Hours of Operations
Ease of placing Orders (telephone, online, fax)
C. General
Would you like your Invoices and Statements emailed?	Yes	No
Would you like a complimentary Systems Procedures Manual?	Yes	No
Would you purchase online? (Manrex online store)	Yes	No
Would you recommend Manrex's products or services to a colleague?	Yes	No
Are you a Manrex member?	Yes	No
If you are not a Manrex member, would you like us to set you up with this complimentary web-based service?	Yes	No
Enter the text as shown in the box:

*Minimum order required: $100.00 before taxes.