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2. First Name*
3. Last Name*
5. Address1*
7. Address2
9. City*
10. State*
11. Zip*
13. Email Address*
15. Phone Number
17. How long have you been a City of Fort Pierce Solid Waste Customer?*

    1. 0 - 3 years
    2. 4 - 7 years
    3. 8 - 11 years

    1. 12- 15 years
    2. +15 years
19. Are you a Residential or Commercial Customer? *

    1. Residential
    2. Commercial
21. Overall, how satisfied are you with our service?*

    1. Very Satisfied
    2. Satisfied
    3. Neutral
    4. Dissatisfied
    5. Very Dissatisfied
23. How would you rate the quality of the service you received? *

    1. Excellent
    2. Good
    3. Fair
    4. Poor
25. How responsive have we been to your questions, requests or concerns?*

    1. Extremely Responsive
    2. Very Responsive
    3. Somewhat Responsive
    4. Not So Responsive
    5. Not at All Responsive
27. Would you recommend our services to others?*

    1. Definitely Yes
    2. Probably Yes
    3. Not Sure
    4. Probably Not
    5. Definitely Not
29. What suggestions do you have for how we can improve our service?
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32. Email address

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33. Submit

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