
This organization   
Customer Loyalty Survey  
 
 
A WalkerInformation* Product 
 
 
 
Please answer each question by checking (
✔
) or filling in (
●
) the circle that best describes how 
you feel.  An example is shown below.  If you change your mind, cross out or erase your answer.
For most questions, labels for the circles are printed at the top of each section.  In this example, 
the five choices range from “Strongly Agree” to “Strongly Disagree.” 
 
Example: 
Strongly 
Agree 
Agree Neither 
Agree nor 
Disagree 
Disagree Strongly 
Disagree 
1.  I am proud to be associated with this organization 
   
❸ 
   
 
Section 1 – Your Feelings About this organization 
How likely are you to … 
Extremely 
Likely 
Very 
Likely 
Somewhat 
Likely 
Not Very 
Likely 
Not At All 
Likely 
a.  Continue buying this organization’s products and/or   
services 
         
 
How much do you agree or disagree that … 
Strongly 
Agree 
Agree Neither 
Agree Nor 
Disagree 
Disagree Strongly 
Disagree 
b.   I am very committed to this organization 
         
c.   It would matter a lot if I could not continue buying from   
     this organization 
         
 
Very 
Satisfied 
Satisfied 
Neither 
Satisfied 
nor 
Dissatisfied 
Dissatisfied
Very 
Dissatisfied
d.   Overall how satisfied are you with this organization 
         
 
Section 2 —Your Relationship with this organization 
 
 
Use this scale to show how much you agree or 
disagree that… 
Strongly 
Agree 
Agree Neither 
Agree Nor 
Disagree 
Disagree Strongly 
Disagree 
a. 
Customers can rely on this organization to deliver 
outstanding quality, service and value 
         
b.  
This organization really cares about building a relationship 
with me 
         
c.  
This organization attracts and retains outstanding people 
to work for them  
         
d.  
This organization sets the standard for excellence in its 
industry 
         
e.  
This organization communicates openly and honestly 
         
f.  
This organization values people and relationships ahead of 
today’s profits 
         
g.  
This organization listens well and responds quickly to  
customer needs 
         
Section 2 —Your Relationship with this organization