Green Cleaner Feedback

Hopefully you have had a chance to try out the sample

We would appreciate knowing what you thought of the biodegradable cleaner we sent to you.

The name and email address are only used to keep track of who received the samples and gave us feedback. They will not be used to send you more information. You will continue to receive periodic information about the environment, Green products and ways to clean healthy with your original sample subscription.

If you want to speak to me personally about the cleaner or have other questions, please leave a phone number.

If you would like other information about environmental, physical or financial health, please follow the links or sign up for our monthly newsletter after you have filled out the sample survey.

We Appreciate you Feedback

Please note that all fields followed by an asterisk must be filled in.

First Name*

First Name*

E-mail Address*

E-mail Address*

Home Phone

I have used the sample to make a bottle of general cleaner*

I have used the sample to make a bottle of general cleaner*

	Yes
	No

If you answered Yes, please rate the cleaner

I have used the sample to make a bottle of window cleaner*

I have used the sample to make a bottle of window cleaner*

	Yes
	No

If you answered Yes, please rate the window cleaner

Additional comments on cleaner abilities

If you havent used your sample yet, do you plan to?

	Yes
	No

Would you recommend this cleaner to a friend?*

Would you recommend this cleaner to a friend?*

	Yes
	No

Why? (click all that apply)*

Why? (click all that apply)*

	How it cleans
	Because its "green"
	Cost

If I told you that you could purchase a bottle of concentrated cleaner that made 48 gallons (384 bottles)of general purpose cleaner, would you buy it if it cost less than $12.