<html>

<head>

<title> feedbackform</title>

</head>

<body>

<center><h1> FEEDBACK FORM</h1></center>

<center><h2>overall statisfaction of service</h2></center>

<table border="4" align="center" cellspacing="1" bordercolor="cyan">

<tr>

<th></th>

<th>Very satisfied</th>

<th>Satisfied</th>

<th>Neutral</th>

<th>Unsatisfied</th>

<th>Very unsatisfied</th>

</tr>

<tr><td>friendliness</td>

<td><center><input type="radio" name=" very satisfied"></center></td>

<td><center><input type="radio" name="satisfied"></center></td>

<td><center><input type="radio" name="neutral"></center></td>

<td><center><input type="radio" name="unsatisfied"></center></td>

<td><center><input type="radio" name="veryunsatisfied"></center></td>

</tr>

<tr><td>knowledge</td>

<td><center><input type="radio" name=" very satisfied"></center></td>

<td><center><input type="radio" name="satisfied"></center></td>

<td><center><input type="radio" name="neutral"></center></td>

<td><center><input type="radio" name="unsatisfied"></center></td>

<td><center><input type="radio" name="veryunsatisfied"></center></td>

</tr>

<tr><td>quickness</td>

<td><center><input type="radio" name=" very satisfied"></center></td>

<td><center><input type="radio" name="satisfied"></center></td>

<td><center><input type="radio" name="neutral"></center></td>

<td><center><input type="radio" name="unsatisfied"></center></td>

<td><center><input type="radio" name="veryunsatisfied"></center></td>

</tr>

</table>

<table border="0" align="center" cellspacing="1">

<center><h3>would you use our customer service in the future</h3></center>

<center><input type="radio" name="service" value="yes">YES<br></center>

<center><input type="radio" name="sevice" value="no">NO<br></center>

<center><input type="radio" name="service" value="maybe">MAYBE<br></center>

</tr>

<center><h3>How can we improve our service?</h3></center>

<center><textarea name="service" rows="10" cols="30"></textarea></center>

<br>

<br>

<center><input type="submit" value="SUBMIT SURVEY"></center>

</body>

</form>

</table>

</html>