Please use this form for your comments, suggestions, or to request information about any of the many programs and services offered by Fairfield Electric Cooperative. We will contact you only in the manner you specify below. If you would like an e-mail response, please be sure to include your e-mail address. 1 Name 2 Mailing address (street or P.O. box) 3 City, state and zip code 6 Phone number at home 7 Phone number at work 8 E-mail address 9 Fairfield Electric account number 10 Your last contact with Fairfield Electric was: By phone By mail By e-mail In person at home In person at work In person elsewhere 11 How would you describe your last contact with Fairfield Electric? Excellent Very good Good Fair Poor 12 How would you describe your overall feeling about Fairfield Electric? Extremely positive Very positive Somewhat positive Neutral Somewhat negative Very negative Extremely negative 13 Is this site easy to navigate? Very easy Somewhat easy Not easy 14 Did you find what you were looking for? Yes No 15 Please use this space to add any additional comments or questions. We're interested in reading your thoughts about the programs and services we offer, electric utility industry restructuring, or any other topic that relates to the job we do for you. 16 Regarding your responses to this survey, please select one of the following options I'd like you to contact me by mail. I'd like you to contact me by e-mail. I'd like you to contact me by phone. No contact is necessary.

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