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2. Disclaimer

   Information submitted on this form will be sent via unsecured email. To protect sensitive information, do not enter the following items or similar information on this form: Social Security numbers, driver’s license numbers, bank account information, routing numbers, credit card numbers, medical information, passport numbers, and passwords. Please review our privacy policy located at www.jeffco.us/privacy. By submitting this form, you acknowledge and accept the terms listed in the privacy policy.

4. How Was Your Service?

   Take our survey to let us know how your service was with the Treasurer or Public Trustee's Office.

6. Which office did you visit?*

   check one

   1. Treasurer
   2. Public Trustee
7. Please rate your overall service:*

   1. Excellent
   2. Good
   3. Average
   4. Poor
   5. Terrible
9. Name*
10. Email*
12. Phone Number*
13. Date/time of your visit*
    Date/time of your visit

    Date/time of your visit
15. Customer service representative:

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17. Additional comments:
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19. 1. Receive an email copy of this form.
20. Email address

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21. Submit

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