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Customer Churn Survey Form
We're sorry to see you go! Please tell us why you're leaving.
Main Reason You're Leaving*
If you chose "Other", please explain.
If you found an alternative to our product/services, please share that information.
Please share how we can improve or product/services.
Would you consider returning in the future?*
Yes No
Overall, how satisfied with your experience with us?
Very Satisfied
Satisfied
Neutral
Unsatisfied
Very Unsatisfied

Very Satisfied	Satisfied	Neutral	Unsatisfied	Very Unsatisfied

Customer Churn Survey Form