Customer Feedback Survey Questionnaire

CUSTOMER FEEDBACK SURVEY QUESTIONNAIRE

This document collects structured feedback from the Customer regarding products and services and simultaneously documents the terms under which feedback is provided and used. Completion and signature certify the accuracy of responses and agreement to the terms set forth in this Questionnaire and Agreement.

Parties

Recitals (WHEREAS)

WHEREAS, Company provides products and related services in the ordinary course of its business, and Company seeks constructive customer feedback to evaluate and improve those products and services; and

WHEREAS, Customer has purchased or used Company products or services and is willing to provide feedback concerning performance, quality, and satisfaction under the terms of this Questionnaire and Agreement; and

WHEREAS, the parties desire to set forth the scope, confidentiality, and usage rights related to Customer feedback, and to record Customer responses for the Company's evaluation and lawful use.

Scope of Work

The Customer's feedback will be used to assess product performance, customer experience, and potential enhancements. The parties acknowledge that this Questionnaire does not itself obligate Company to perform additional services beyond those already contracted, except as expressly set forth below.

Payment Terms (If Applicable)

If Company compensates Customer for participation in surveys or panels, payment will be made in accordance with the schedule below. All payments are subject to the terms set forth here, and failure to pay timely entitles the non-breaching party to pursue remedies available at law.

Term and Termination

This Questionnaire and the obligations contained herein commence and terminate as provided below. Either party may terminate for material breach not cured within the notice period specified.

Start Date: — End Date:

Confidentiality

The parties acknowledge that certain information disclosed during the feedback process may be confidential. Each party shall maintain such Confidential Information in strict confidence and shall not disclose it to third parties except (a) by written consent of the disclosing party, (b) as required by law, or (c) to employees, contractors, or agents with a need to know who are bound to confidentiality obligations no less protective than those contained herein. Confidential Information does not include information that is or becomes publicly available through no breach of this Agreement or that was independently developed by the receiving party without use of the disclosing party's Confidential Information.

Customer acknowledges that Company may use aggregated, anonymous feedback for product development and marketing, provided such use does not identify Customer or disclose Confidential Information.

I acknowledge and agree to the Confidentiality terms:

Governing Law

This Questionnaire and any dispute or claim arising out of or in connection with it shall be governed by and construed in accordance with the laws of the state identified below, without regard to conflict of law principles.

Entire Agreement

This Questionnaire, together with any written attachments or appendices executed by the parties, constitutes the entire agreement between the parties concerning the subject matter herein and supersedes all prior negotiations, understandings, and agreements, whether written or oral. Any amendment must be in writing and signed by authorized representatives of both parties.

Customer Feedback Survey

Purchase / Use Date:

1 — Very Dissatisfied 2 — Dissatisfied 3 — Neutral 4 — Satisfied 5 — Very Satisfied

1 2 3 4 5

1 2 3 4 5

Online portal Mobile app Phone support In-person service

Customer consents to be contacted for clarifying feedback: If yes, preferred contact method:

Customer representative completing this form:

Acknowledgment and Signature

By signing below, the undersigned each represent and warrant that they are authorized to execute this Questionnaire and Agreement on behalf of their respective parties, attest that responses are true and accurate to the best of their knowledge, and agree that Customer feedback may be used as provided herein.

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