Customer Comment Form

Division:* 

Location of Visit: * 

Date of Visit:* 

Time of Visit: *   AM PM


First Name:*

Last Name:*

Email*
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Phone

Would you like us to contact you?

(Information is still required)


Tell us how we are doing!

How often do you visit our store during a typical week?
 1-2 3-more Daily

Please rate the following:

Employees were friendly and courteous throughout the store.
 Excellent Good Fair Poor

Employees were helpful and able to answer your questions about the products.
 Excellent Good Fair Poor

The checkout process was fast and efficient.
 Excellent Good Fair Poor

The store has all of the products I was looking for, in stock, when I need them.
 Excellent Good Fair Poor

The stores appearance is neat and clean.
 Excellent Good Fair Poor

The main reason(s) you shop here is because of:

 Convenience Price Product Selection Quality Service Other

Comments:


Product Suggestion:

If suggesting a product, please be sure to provide your contact information:

Product Name:

Size:

Currently able to purchase at:

Price Paid:

UPC CODE:



One Last Thing...

For security purposes, please complete the following equation:

3 + 3 =?