Your participation qualifies you for a chance to win a prize!
  $500 in United Gift Cards!



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Please see below for the location
of the Survey Number on your receipt.
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Amazon Kindle DX Wireless Reader.
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Enter Survey Number: (More Info)  

 




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Overall Satisfaction with the visit:
Quality of Products:
Variety of Selection:
Overall Value:
Items In-stock:
Staff Friendliness:
Speed of Service:
Staff Helpfulness:
Store Appearance and Cleanliness:
Staff Appearance and Cleanliness:
Restroom Appearance and Cleanliness (optional):
Did we greet or welcome you throughout the store?
Did we suggest additional products?
Did the cashier ask for your Rewards account number?
Did you find everything you were looking for?
Please explain below.
Did we make a positive difference in your day?
How likely would you be to recommend us to a friend:
Rank overall satisfaction with the Rewards program:
Would you like to be contacted about your visit?
How could we improve your shopping experience?
Please fill out the following to be entered into the drawing. If you do not fill out all of the fields, you will not be entered into the drawing. If you do not wish to participate in the drawing just click Finish.
Name:
Are you 18 years of age or older?
email:
Phone:
Zipcode:
Rewards No: (Not Required)
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