Multi-Location POS Feedback Form
Share your experience at our various locations to help us improve our service.
Select the location you visited
*
Please Select
Downtown Branch
Mall Kiosk
Airport Terminal
Suburban Outlet
Other
Date and time of your visit
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Type of visit
*
Purchase
Return/Exchange
Inquiry Only
Other
How would you rate the staff's friendliness and helpfulness?
*
1
2
3
4
5
How satisfied were you with the transaction speed?
*
1
2
3
4
5
How clean and organized was the location?
*
1
2
3
4
5
Was your issue or request resolved during your visit?
*
Yes
No
Partially
Please rate your overall experience
*
Very Poor
1
2
3
4
5
6
7
8
9
Excellent
10
1 is Very Poor, 10 is Excellent
Additional comments or suggestions
Would you like to be contacted about your feedback?
*
Yes, please contact me
No, I do not wish to be contacted
Your name (optional)
First Name
Last Name
Your email address (optional, for follow-up)
example@example.com
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