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Name*
First Last
Email*
Phone*
Address
Street Address City State ZIP Code
Date Visited*
Date Format: MM slash DD slash YYYY
Number of Visits*
Invoice Number From Last Visit*
Store Location*
On a Scale of 1 to 10 did employees have a Super Friendly and Out Going attitudes?*
Did employee address you by name and/or title?
- Yes
- No
Was the Full Service Oil Change explained to you?
- Yes
- No
Were you offered additional services based on the manufacturer's recommendations?
- Yes
- No
Were the benefits of those additional services explained to you?
- Yes
- No
Was your windshield cleaned?
- Yes
- No
Was your tire pressure checked?
- Yes
- No
Upon receipt of the invoice did the employee explain all the services performed?
- Yes
- No
Were the employees' appearances acceptable?
- Yes
- No
Was the store's appearances acceptable?
- Yes
- No
Please note any employee names you remember:
Any additional comments or suggestions on how we can better serve you?

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