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Exit Survey
 
How satisfied are you with the following:
Very Dissatisfied Not Satisfied Neutral Satisfied Very Satisfied N/A
Website
Customer Service
Overall
 
 
 
Please allocate 100 points on how you spend your income:
Essentials (Gas, Grocery etc.)
Entertainment (Movies, Clubs etc.)
Other
0
 
 
 
Please rank (1-3) the following in order of interest:
Drag your choices here to rank them
     
     
     
    What types of credit cards do you have (Select all that apply)?
     
    Visa
     
    Mastercard
     
    American Express
     
    Discover
     
    Diners Club
     
    Other
     

     
     
     
    Please choose your favourite ice cream flavour:
    Strawberry
    Butterscotch
    Vanilla
    Chocolate
     
     
     
    What is your date of birth?
    MonthDayYear
      
     
     
    Contact Information
    First Name : 
    Last Name : 
    Phone : 
    Email Address :