Customer Feedback Form

Amideast is committed to providing quality, results-oriented courses, programs, and services to its customers and client organizations. Please use this form to convey your complaint, comment, or suggestion to us.

CUSTOMER INFORMATION

Name *

Organization (If Applicable)

Address

City *

Country *

Phone Number *

Email Address *

FEEDBACK DETAILS

Detail

This feedback pertains to an incident or event that took place on a specific date (if applicable):

(Month, Date, Year)

This feedback pertains to the AMIDEAST office located in *

(City, Country)

Please provide the details of your feedback here *

Please indicate if you are requesting a remedy *

Yes

CUSTOMER CONFIRMATION AND DATE

Name *

(Printed)

Confirmation *

Agree

By submitting this form, I hereby confirm that I am the individual whose name appears above and who is submitting this form.

Date *

(Month, Date, Year)

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Customer Feedback Form

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