Customer Feedback Form for Google Reviews

Customer Feedback Form for Google Reviews

Business Name:    Customer Name:

Effective Date:

WHEREAS

WHEREAS, Business provides goods and/or services to customers and solicits consumer feedback to improve service quality and support marketing efforts; and

WHEREAS, Customer has received services or goods from Business and is willing to provide an honest review and feedback that Business may publish on public review platforms including Google Reviews; and

WHEREAS, Business requires a written authorization from Customer to collect, use, and publish Customer feedback in accordance with the terms of this Agreement.

SCOPE OF WORK

Customer will provide feedback describing their experience with Business's products or services. Customer acknowledges that feedback may be edited for length and formatting but will not be altered substantively without Customer's consent.

Date of Service:

5 - Excellent 4 - Very Good 3 - Good 2 - Fair 1 - Poor

PAYMENT TERMS

If Business offers an incentive in exchange for feedback, the parties agree as follows:

TERM AND TERMINATION

This Agreement commences on the Start Date and continues until the End Date unless earlier terminated in accordance with this section.

Start Date:

End Date:

Either party may terminate this Agreement for material breach if the breaching party fails to cure within the notice period specified above. Termination does not relieve obligations accrued prior to termination.

CONFIDENTIALITY

The parties acknowledge that Customer feedback submitted here may contain personal or sensitive information. Business will not disclose confidential business information of Customer or proprietary Business information except as necessary to publish the review as authorized. Confidential information does not include information that is already publicly available or required to be disclosed by law.

Customer represents and warrants that the content of the feedback is the Customer's original expression and does not infringe third-party rights. Customer agrees not to disclose Business internal trade secrets when providing feedback.

CONSENT AND AUTHORIZATION

By checking the boxes below and signing this Agreement, Customer grants Business the rights described in this Consent and Authorization section.

Customer consents to Business publishing Customer's feedback on public review platforms including Google Reviews and acknowledges that such publication may be publicly viewable.

Customer consents to minor edits for length, grammar, and formatting that do not materially alter content.

Customer consents to Business using Customer's first name or initials in connection with published feedback; Business will not disclose personal contact details without separate consent.

GOVERNING LAW

This Agreement shall be governed by and construed in accordance with the laws of the State of , without regard to its conflicts of law principles.

ENTIRE AGREEMENT

This Agreement constitutes the entire agreement between the parties with respect to the subject matter hereof and supersedes all prior and contemporaneous agreements, proposals, and communications, whether oral or written. Any modification to this Agreement must be in writing and signed by both parties.

REPRESENTATIONS AND WARRANTIES

Customer represents that Customer is at least 18 years of age, has full legal capacity to enter this Agreement, and that the feedback is truthful to the best of Customer's knowledge. Business represents that it will not alter material content of Customer's feedback without Customer's consent.

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