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Customer Feed back Form
Questions marked by * are required.
1. Product Name *
2. Packing Quantity Purchased *
3. No of Bottles Purchased *
4. Purchased From *
5. Name and Address of the Supplier *
6. Price Paid for the Product in Rs. *
7. Whether regularly used as advised? *
8. Customer Experience *
9. Benefits Derived *
10. Is Product working as claimed on the label? *
11. Complaints if any *
12. If Complaints or Compliments please write *
13. Will you buy this product again? *
14. Will you recommend this product to your friends? *
15. Will you buy other products of Dinlog? *
16. Have You fully seen our Website? *
17. Do You want to be an Agent for Dlog Technologies Products? *
18. Your Name *
19. Email
20. Your Contact Address with Phone Number *
21. Any other information or suggestions *