Call us today! (716) 759-6811

Enhancing the independence of physically challenged people using state-of-the-art adaptive equipment.

Customer Survey

Dear Customer:

In an effort to provide the best possible service to our valued clients, you have been randomly selected to complete a brief survey regarding your recent visit to Main Mobility. As a token of our appreciation, we have included a certificate for 10% off of your next purchase with us (maximum value $50.00), which will be validated upon receipt of this completed survey. Please take a few minutes to provide us with valuable feedback about our company’s, service, and the products we provide. Keep in mind that all responses will be kept anonymous and/or confidential. We appreciate your input!

Sincerely,

Tom Lorentz
President

What was the purpose of your most recent visit to Main Mobility? (ex. sales, service, warranty service) : 
For whom was the purchase or modification for? (eg. self, child, spouse, parent, etc.) : 
Please tell us what type of modification was made to your vehicle. (eg. hand controls, spinner knob, left-foot gas pedal, etc.) : 
If you purchased a mobility vehicle from Main Mobility, did you purchase a...
 new vehicle with a new conversion
 used vehicle with a new conversion
 used vehicle with a used conversion
Have any other mobility modifications been done to it?
 yes  no
If so, what?
How satisfied are you with...
(1 being the lowest and 5 being the higest)
Your purchase experience : 
 1  2  3  4  5
Our product knowledge : 
 1  2  3  4  5
Your salesperson/mobility consultant?
 1  2  3  4  5
The product you purchased?
 1  2  3  4  5
Ease of making an appointment for service?
 1  2  3  4  5
Our service?
 1  2  3  4  5
Our hours of operation?
 1  2  3  4  5
Our company overall?
 1  2  3  4  5
How likely are you to...
(1 being the lowest and 5 being the higest)
Buy from us again?
 1  2  3  4  5
Recommend our products/services to others?
 1  2  3  4  5
Recommend our company to others?
 1  2  3  4  5
Did you get a tour of our service department?
 yes  no
Did you meet our service manager?
 yes  no
How did you first hear of Main Mobility?
Have you seen or heard any Main Mobility advertisements (billboards, newspaper ads, radio or television commercials, etc.)?
If so, what?
Have you seen Main Mobility at any community events (auto shows, conventions, trade shows, etc.)?
If so, where?
Please tell us a bit about yourself...
Age : 
Gender : 
 M  F
Marital status : 
Annual household income : 
 less than $50,000  $50,000-$100,000  $100,000+
What other vehicles do you currently have in your household?
Do you currently have, or have you previously owned any other mobility equipped vehicles?
If so, what year, make & model were they and when did you own them?
Do you have any additional comments, suggestions, or feedback?
Do you have any unresolved issues that require additional attention?
Name : 
Address : 
City : 
State : 
Zip : 
Phone Number : 
Email Address : 
Description of your issue : 



Privacy Notice Re: Information Collection, Use, and Sharing: We only have access to personal information that you voluntarily submit via this survey, email, or from other direct contact. This information is soley used to contact you only if you have specifically requested that we do so. We will not sell or rent this information to anyone. We will not share your information with any third party outside of our organization, other than as necessary to fulfill your request.