Customer Retention Loyalty Questionnaire


A customer retention loyalty questionnaire is an important tool that can be used to find out reasons or causes for making customers stop buying a company’s products or stop using their services.  Any business or organization that requires customers in order to remain relevant and make a profit needs to find out ahead of time reasons that could see customers stop using their services or stop buying their products or goods.  A customer retention loyalty questionnaire is a great way of getting this information that could prove critical when it comes to staying afloat especially during these difficult economic times.

Sample Customer Retention Loyalty Questionnaire

Customer’s name: ________________________________________________________

Address (optional): ________________________________________________________

Date: ___________________________________________________________________

Please confirm whether or not you have stopped using the company’s services:

Yes: ___________________________________________________________________

No: ____________________________________________________________________

Please indicate the duration spent using the company’s services:

________________________________________________________________________

Please indicate when you stopped using the company’s services:

________________________________________________________________________

Please indicate details about the person you informed about your cancellation:

Name: __________________________________________________________________

Position: ________________________________________________________________

Date: ___________________________________________________________________

Please indicate the method you used to inform them about your cancellation:

Telephone: ______________________________________________________________

Email: __________________________________________________________________

Letter: __________________________________________________________________

Other (please specify): _____________________________________________________

Please describe the reasons that forced you to terminate the company’s services:

________________________________________________________________________________________________________________________________________________

Please describe reasons that would have ensured your continued use of the company’s services:

________________________________________________________________________________________________________________________________________________

Please indicate whether you hired a new company to provide you with similar services (Yes or No):

___________________________________________________________________

____________________________________________________________________

Please indicate whether you are satisfied with the new company’s services (Yes or No):

___________________________________________________________________

____________________________________________________________________

Please give any additional comments:

________________________________________________________________________________________________________________________________________________

_____________________________________________________________________________________________________________________________

Category: Customer Questionnaire

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