Onsite Sewage Disposal System Maintenance


Contact Us

Just fill out this simple form to contact us with any questions or comments you might have. Areas in bold print are required in order to send this form.


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Note:   There are a few optional questions at the bottom of this form. We would appreciate it if you fill them out, so that we can have your feedback on our performance, and on our web site. Please take the time to fill them out before submitting this form. Thank you very much.
If you would like to skip over these questions, click here to move to the bottom of the form, where you will find the submission button.

Optional Information
1.   Has SeptiClean, Inc. ever done work for you?

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.

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?

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.

Website Feedback
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3.   On a scale of 1 to 5, how would you rate the information found on this web site?
4.   On a scale of 1 to 5, how would you rate the appearance of this web site?
5.   On a scale of 1 to 5, how easy is it to navigate this web site?
6.   If you have any suggestions on how to improve the web site, or you would like to mention something specific that you like/dislike about the web site, please make those comments in the space provided below.


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This page was created by Curtiss Grymala for Ten-321 Enterprises
and was last updated on September 22, 2002

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