| Optional Information |
| 1.   Has SeptiClean, Inc. ever done work for you? | |
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| If you answer "yes" to Question 1, please answer questions 2 through 5.   If you answer "no" to Question 1, please answer questions 5 and 6. |
| 2.   Were you satisfied with that work? | |
| 3.   Who did the work for you? | |
| 4.   What kind of work did they perform? | |
5.   If you have any comments concerning the work we performed for you, please put them in the box below. Thank you.
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| 6.   Are you planning on contracting SeptiClean, Inc. to do work for you? | |
| 7.   If yes, what kind of work would you want them to perform? | |
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| 8.   How did you hear about SeptiClean, Inc.? | |
If you selected Health Dept, Web Search Engine, Contractor, or Friend, please tell us which one. If you chose Other, please elaborate. Thank you. |