Customer Feedback Form

Amideast is committed to providing quality, results-oriented courses, programs, and services to its customers and client organizations. Please use this form to convey your complaint, comment, or suggestion to us.

CUSTOMER INFORMATION

Name

Organization (If Applicable)

Address

City

Phone Number

Email Address

FEEDBACK DETAILS

This feedback pertains to

Course

Program

Service

Facility

Other (please describe below)

This feedback pertains to an incident or event that took place on a specific date (if applicable):

(Month, Date, Year)

This feedback pertains to the AMIDEAST office located in

(City, Country)

Please provide the details of your feedback here

Please indicate if you are requesting a remedy

Yes

No

CUSTOMER CONFIRMATION AND DATE

Name

(Printed)

Confirmation

Agree

By submitting this form, I hereby confirm that I am the individual whose name appears above and who is submitting this form.

Date

(Month, Date, Year)

CAPTCHA

This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.

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