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<form method="post" action="">
  <div class="container">
    <table style="border: 2px solid black; padding: 10px; width: 600px;">
      <tbody>
        <tr>
          <td colspan="2" style="text-align: center;">
            <span style="color: #fa0e2f; font-size: 10px;">Details are required - Your personal details will remain confidential with us.</span>
          </td>
        </tr>
        <tr>
          <td><strong>Name of the Organization:</strong></td>
          <td><input type="text" id="organization" name="organization" style="width: 300px;" required=""></td>
        </tr>
        <tr>
          <td><strong>Department:</strong></td>
          <td><input type="text" id="dpt" name="dpt" style="width: 300px;" required=""></td>
        </tr>
        <tr>
          <td><strong>Full Name:</strong></td>
          <td><input type="text" id="pic" name="pic" style="width: 300px;" required=""></td>
        </tr>
        <tr>
          <td><strong>Email Address:</strong></td>
          <td><input type="email" id="email" name="email" style="width: 300px;" required=""></td>
        </tr>
      </tbody>
    </table>
  </div>
  <p>Answer the following questions in the scale of 1 to 10, where <strong>1 is the lowest and 10 will be the highest rating</strong>.</p>
  <!-- question 1 -->
  <hr class="survey-hr">
  <label>1. Please rate your level of satisfaction with Mitsui Chemicals India's products and services.</label>
  <div style="color: grey">
    <span style="float: left"> Not Likely </span>
    <span style="float: right"> Very Likely </span>
  </div>
  <span class="scale-rating">
    <label>
      <input type="radio" name="rating1" value="1">
      <span>1</span>
    </label>
    <label>
      <input type="radio" name="rating1" value="2">
      <span>2</span>
    </label>
    <label>
      <input type="radio" name="rating1" value="3">
      <span>3</span>
    </label>
    <label>
      <input type="radio" name="rating1" value="4">
      <span>4</span>
    </label>
    <label>
      <input type="radio" name="rating1" value="5">
      <span>5</span>
    </label>
    <label>
      <input type="radio" name="rating1" value="6">
      <span>6</span>
    </label>
    <label>
      <input type="radio" name="rating1" value="7">
      <span>7</span>
    </label>
    <label>
      <input type="radio" name="rating1" value="8">
      <span>8</span>
    </label>
    <label>
      <input type="radio" name="rating1" value="9">
      <span>9</span>
    </label>
    <label>
      <input type="radio" name="rating1" value="10">
      <span>10</span>
    </label>
  </span>
  <div class="clear"></div>
  <div class="clear"></div>
  <!-- New field: Suggestion text box -->
  <div id="suggestion-box1" class="hidden">
    <label for="suggestion1">Please suggest how can we improve:</label><br>
    <textarea name="suggestion1" id="suggestion1" rows="4" cols="50"></textarea>
  </div>
  <!-- question 2 -->
  <hr class="survey-hr">
  <label>2. How likely are you to recommend our products/services within your industry?</label>
  <div style="color: grey">
    <span style="float: left"> Not Likely </span>
    <span style="float: right"> Very Likely </span>
  </div>
  <span class="scale-rating">
    <label>
      <input type="radio" name="rating2" value="1">
      <span>1</span>
    </label>
    <label>
      <input type="radio" name="rating2" value="2">
      <span>2</span>
    </label>
    <label>
      <input type="radio" name="rating2" value="3">
      <span>3</span>
    </label>
    <label>
      <input type="radio" name="rating2" value="4">
      <span>4</span>
    </label>
    <label>
      <input type="radio" name="rating2" value="5">
      <span>5</span>
    </label>
    <label>
      <input type="radio" name="rating2" value="6">
      <span>6</span>
    </label>
    <label>
      <input type="radio" name="rating2" value="7">
      <span>7</span>
    </label>
    <label>
      <input type="radio" name="rating2" value="8">
      <span>8</span>
    </label>
    <label>
      <input type="radio" name="rating2" value="9">
      <span>9</span>
    </label>
    <label>
      <input type="radio" name="rating2" value="10">
      <span>10</span>
    </label>
  </span>
  <div class="clear"></div>
  <div class="clear"></div>
  <!-- New field: Suggestion text box -->
  <div id="suggestion-box2" class="hidden">
    <label for="suggestion2">Please suggest how can we improve:</label><br>
    <textarea name="suggestion2" id="suggestion2" rows="4" cols="50"></textarea>
  </div>
  <!-- question 3 -->
  <hr class="survey-hr">
  <label>3. On a scale of 1-10 how much value does our product adds to your business?</label>
  <div style="color: grey">
    <span style="float: left"> Not Likely </span>
    <span style="float: right"> Very Likely </span>
  </div>
  <span class="scale-rating">
    <label>
      <input type="radio" name="rating3" value="1">
      <span>1</span>
    </label>
    <label>
      <input type="radio" name="rating3" value="2">
      <span>2</span>
    </label>
    <label>
      <input type="radio" name="rating3" value="3">
      <span>3</span>
    </label>
    <label>
      <input type="radio" name="rating3" value="4">
      <span>4</span>
    </label>
    <label>
      <input type="radio" name="rating3" value="5">
      <span>5</span>
    </label>
    <label>
      <input type="radio" name="rating3" value="6">
      <span>6</span>
    </label>
    <label>
      <input type="radio" name="rating3" value="7">
      <span>7</span>
    </label>
    <label>
      <input type="radio" name="rating3" value="8">
      <span>8</span>
    </label>
    <label>
      <input type="radio" name="rating3" value="9">
      <span>9</span>
    </label>
    <label>
      <input type="radio" name="rating3" value="10">
      <span>10</span>
    </label>
  </span>
  <div class="clear"></div>
  <div class="clear"></div>
  <!-- New field: Suggestion text box -->
  <div id="suggestion-box3" class="hidden">
    <label for="suggestion3">Please suggest how can we improve:</label><br>
    <textarea name="suggestion3" id="suggestion3" rows="4" cols="50"></textarea>
  </div>
  <!-- question 4 -->
  <hr class="survey-hr">
  <label>4. Please rate the quality of the packaging of our products.</label>
  <div style="color: grey">
    <span style="float: left"> Not Likely </span>
    <span style="float: right"> Very Likely </span>
  </div>
  <span class="scale-rating">
    <label>
      <input type="radio" name="rating4" value="1">
      <span>1</span>
    </label>
    <label>
      <input type="radio" name="rating4" value="2">
      <span>2</span>
    </label>
    <label>
      <input type="radio" name="rating4" value="3">
      <span>3</span>
    </label>
    <label>
      <input type="radio" name="rating4" value="4">
      <span>4</span>
    </label>
    <label>
      <input type="radio" name="rating4" value="5">
      <span>5</span>
    </label>
    <label>
      <input type="radio" name="rating4" value="6">
      <span>6</span>
    </label>
    <label>
      <input type="radio" name="rating4" value="7">
      <span>7</span>
    </label>
    <label>
      <input type="radio" name="rating4" value="8">
      <span>8</span>
    </label>
    <label>
      <input type="radio" name="rating4" value="9">
      <span>9</span>
    </label>
    <label>
      <input type="radio" name="rating4" value="10">
      <span>10</span>
    </label>
  </span>
  <div class="clear"></div>
  <div class="clear"></div>
  <!-- New field: Suggestion text box -->
  <div id="suggestion-box4" class="hidden">
    <label for="suggestion4">Please suggest how can we improve:</label><br>
    <textarea name="suggestion4" id="suggestion4" rows="4" cols="50"></textarea>
  </div>
  <!-- question 5 -->
  <hr class="survey-hr">
  <label>5. Please rate the consistency of the product quality with the delivery specification</label>
  <div style="color: grey">
    <span style="float: left"> Not Likely </span>
    <span style="float: right"> Very Likely </span>
  </div>
  <span class="scale-rating">
    <label>
      <input type="radio" name="rating5" value="1">
      <span>1</span>
    </label>
    <label>
      <input type="radio" name="rating5" value="2">
      <span>2</span>
    </label>
    <label>
      <input type="radio" name="rating5" value="3">
      <span>3</span>
    </label>
    <label>
      <input type="radio" name="rating5" value="4">
      <span>4</span>
    </label>
    <label>
      <input type="radio" name="rating5" value="5">
      <span>5</span>
    </label>
    <label>
      <input type="radio" name="rating5" value="6">
      <span>6</span>
    </label>
    <label>
      <input type="radio" name="rating5" value="7">
      <span>7</span>
    </label>
    <label>
      <input type="radio" name="rating5" value="8">
      <span>8</span>
    </label>
    <label>
      <input type="radio" name="rating5" value="9">
      <span>9</span>
    </label>
    <label>
      <input type="radio" name="rating5" value="10">
      <span>10</span>
    </label>
  </span>
  <div class="clear"></div>
  <div class="clear"></div>
  <!-- New field: Suggestion text box -->
  <div id="suggestion-box5" class="hidden">
    <label for="suggestion5">Please suggest how can we improve:</label><br>
    <textarea name="suggestion5" id="suggestion5" rows="4" cols="50"></textarea>
  </div>
  <!-- question 6 -->
  <hr class="survey-hr">
  <label>6. Please rate the delivery time of receiving the goods.</label>
  <div style="color: grey">
    <span style="float: left"> Not Likely </span>
    <span style="float: right"> Very Likely </span>
  </div>
  <span class="scale-rating">
    <label>
      <input type="radio" name="rating6" value="1">
      <span>1</span>
    </label>
    <label>
      <input type="radio" name="rating6" value="2">
      <span>2</span>
    </label>
    <label>
      <input type="radio" name="rating6" value="3">
      <span>3</span>
    </label>
    <label>
      <input type="radio" name="rating6" value="4">
      <span>4</span>
    </label>
    <label>
      <input type="radio" name="rating6" value="5">
      <span>5</span>
    </label>
    <label>
      <input type="radio" name="rating6" value="6">
      <span>6</span>
    </label>
    <label>
      <input type="radio" name="rating6" value="7">
      <span>7</span>
    </label>
    <label>
      <input type="radio" name="rating6" value="8">
      <span>8</span>
    </label>
    <label>
      <input type="radio" name="rating6" value="9">
      <span>9</span>
    </label>
    <label>
      <input type="radio" name="rating6" value="10">
      <span>10</span>
    </label>
  </span>
  <div class="clear"></div>
  <div class="clear"></div>
  <!-- New field: Suggestion text box -->
  <div id="suggestion-box6" class="hidden">
    <label for="suggestion6">Please suggest how can we improve:</label><br>
    <textarea name="suggestion6" id="suggestion6" rows="4" cols="50"></textarea>
  </div>
  <!-- question 7 -->
  <hr class="survey-hr">
  <label>7. Please rate your level of satisfaction with our Technical Support.</label>
  <div style="color: grey">
    <span style="float: left"> Not Likely </span>
    <span style="float: right"> Very Likely </span>
  </div>
  <span class="scale-rating">
    <label>
      <input type="radio" name="rating7" value="1">
      <span>1</span>
    </label>
    <label>
      <input type="radio" name="rating7" value="2">
      <span>2</span>
    </label>
    <label>
      <input type="radio" name="rating7" value="3">
      <span>3</span>
    </label>
    <label>
      <input type="radio" name="rating7" value="4">
      <span>4</span>
    </label>
    <label>
      <input type="radio" name="rating7" value="5">
      <span>5</span>
    </label>
    <label>
      <input type="radio" name="rating7" value="6">
      <span>6</span>
    </label>
    <label>
      <input type="radio" name="rating7" value="7">
      <span>7</span>
    </label>
    <label>
      <input type="radio" name="rating7" value="8">
      <span>8</span>
    </label>
    <label>
      <input type="radio" name="rating7" value="9">
      <span>9</span>
    </label>
    <label>
      <input type="radio" name="rating7" value="10">
      <span>10</span>
    </label>
  </span>
  <div class="clear"></div>
  <div class="clear"></div>
  <!-- New field: Suggestion text box -->
  <div id="suggestion-box7" class="hidden">
    <label for="suggestion7">Please suggest how can we improve:</label><br>
    <textarea name="suggestion7" id="suggestion7" rows="4" cols="50"></textarea>
  </div>
  <!-- question 8 -->
  <hr class="survey-hr">
  <label>8. Please rate your purchase experience with Mitsui Chemicals India.</label>
  <div style="color: grey">
    <span style="float: left"> Not Likely </span>
    <span style="float: right"> Very Likely </span>
  </div>
  <span class="scale-rating">
    <label>
      <input type="radio" name="rating8" value="1">
      <span>1</span>
    </label>
    <label>
      <input type="radio" name="rating8" value="2">
      <span>2</span>
    </label>
    <label>
      <input type="radio" name="rating8" value="3">
      <span>3</span>
    </label>
    <label>
      <input type="radio" name="rating8" value="4">
      <span>4</span>
    </label>
    <label>
      <input type="radio" name="rating8" value="5">
      <span>5</span>
    </label>
    <label>
      <input type="radio" name="rating8" value="6">
      <span>6</span>
    </label>
    <label>
      <input type="radio" name="rating8" value="7">
      <span>7</span>
    </label>
    <label>
      <input type="radio" name="rating8" value="8">
      <span>8</span>
    </label>
    <label>
      <input type="radio" name="rating8" value="9">
      <span>9</span>
    </label>
    <label>
      <input type="radio" name="rating8" value="10">
      <span>10</span>
    </label>
  </span>
  <div class="clear"></div>
  <div class="clear"></div>
  <!-- New field: Suggestion text box -->
  <div id="suggestion-box8" class="hidden">
    <label for="suggestion8">Please suggest how can we improve:</label><br>
    <textarea name="suggestion8" id="suggestion8" rows="4" cols="50"></textarea>
  </div>
  <!-- question 9 -->
  <hr class="survey-hr">
  <label>9. Please rate your experience on Mitsui Chemicals India's LinkedIn page and website</label>
  <div style="color: grey">
    <span style="float: left"> Not Likely </span>
    <span style="float: right"> Very Likely </span>
  </div>
  <span class="scale-rating">
    <label>
      <input type="radio" name="rating9" value="1">
      <span>1</span>
    </label>
    <label>
      <input type="radio" name="rating9" value="2">
      <span>2</span>
    </label>
    <label>
      <input type="radio" name="rating9" value="3">
      <span>3</span>
    </label>
    <label>
      <input type="radio" name="rating9" value="4">
      <span>4</span>
    </label>
    <label>
      <input type="radio" name="rating9" value="5">
      <span>5</span>
    </label>
    <label>
      <input type="radio" name="rating9" value="6">
      <span>6</span>
    </label>
    <label>
      <input type="radio" name="rating9" value="7">
      <span>7</span>
    </label>
    <label>
      <input type="radio" name="rating9" value="8">
      <span>8</span>
    </label>
    <label>
      <input type="radio" name="rating9" value="9">
      <span>9</span>
    </label>
    <label>
      <input type="radio" name="rating9" value="10">
      <span>10</span>
    </label>
  </span>
  <div class="clear"></div>
  <div class="clear"></div>
  <!-- New field: Suggestion text box -->
  <div id="suggestion-box9" class="hidden">
    <label for="suggestion9">Please suggest how can we improve:</label><br>
    <textarea name="suggestion9" id="suggestion9" rows="4" cols="50"></textarea>
  </div>
  <!-- question 10 -->
  <hr class="survey-hr">
  <label>10. Please share if you have any Suggestions for Mitsui Chemicals India Pvt Ltd</label>
  <div id="suggestion-box10">
    <label for="suggestion10">Please suggest how can we improve:</label><br>
    <textarea name="suggestion10" id="suggestion10" rows="10" cols="70"></textarea>
  </div>
  <input style="background:#43a7d5;color:#fff;padding:12px;border:0" type="submit" value="Submit your review">&nbsp; <p>Copyright ©2023 | All Rights Reserved</p>
</form>

Text Content

CUSTOMER FEEDBACK FORM

Dear Customer,
Thank you for choosing Mitsui Chemicals India Pvt. Ltd. Please spare some
moments to give us your valuable feedback as it will help us in improving our
service.

Details are required - Your personal details will remain confidential with us.
Name of the Organization: Department: Full Name: Email Address:

Answer the following questions in the scale of 1 to 10, where 1 is the lowest
and 10 will be the highest rating.

--------------------------------------------------------------------------------

1. Please rate your level of satisfaction with Mitsui Chemicals India's products
and services.
Not Likely Very Likely
1 2 3 4 5 6 7 8 9 10


Please suggest how can we improve:


--------------------------------------------------------------------------------

2. How likely are you to recommend our products/services within your industry?
Not Likely Very Likely
1 2 3 4 5 6 7 8 9 10


Please suggest how can we improve:


--------------------------------------------------------------------------------

3. On a scale of 1-10 how much value does our product adds to your business?
Not Likely Very Likely
1 2 3 4 5 6 7 8 9 10


Please suggest how can we improve:


--------------------------------------------------------------------------------

4. Please rate the quality of the packaging of our products.
Not Likely Very Likely
1 2 3 4 5 6 7 8 9 10


Please suggest how can we improve:


--------------------------------------------------------------------------------

5. Please rate the consistency of the product quality with the delivery
specification
Not Likely Very Likely
1 2 3 4 5 6 7 8 9 10


Please suggest how can we improve:


--------------------------------------------------------------------------------

6. Please rate the delivery time of receiving the goods.
Not Likely Very Likely
1 2 3 4 5 6 7 8 9 10


Please suggest how can we improve:


--------------------------------------------------------------------------------

7. Please rate your level of satisfaction with our Technical Support.
Not Likely Very Likely
1 2 3 4 5 6 7 8 9 10


Please suggest how can we improve:


--------------------------------------------------------------------------------

8. Please rate your purchase experience with Mitsui Chemicals India.
Not Likely Very Likely
1 2 3 4 5 6 7 8 9 10


Please suggest how can we improve:


--------------------------------------------------------------------------------

9. Please rate your experience on Mitsui Chemicals India's LinkedIn page and
website
Not Likely Very Likely
1 2 3 4 5 6 7 8 9 10


Please suggest how can we improve:


--------------------------------------------------------------------------------

10. Please share if you have any Suggestions for Mitsui Chemicals India Pvt Ltd
Please suggest how can we improve:

 

Copyright ©2023 | All Rights Reserved