Vehicle Refueling Service Survey
Please share your feedback about your recent vehicle refueling experience to help us improve our service.
Date of your visit
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Which refueling station did you visit?
*
Please Select
Station A
Station B
Station C
Other
Type of fuel purchased
*
Gasoline
Diesel
LPG
Other
How would you rate the cleanliness of the station?
*
1
2
3
4
5
How satisfied were you with the speed of service?
*
1
2
3
4
5
Please evaluate the following aspects of your experience.
*
Rows
Very Dissatisfied
Dissatisfied
Neutral
Satisfied
Very Satisfied
Staff friendliness
1
2
3
4
5
Availability of fuel types
6
7
8
9
10
Ease of payment
11
12
13
14
15
Clarity of signage
16
17
18
19
20
Did you encounter any issues during your visit?
*
No issues
Minor issues
Major issues
How likely are you to recommend our refueling service to others?
*
Not at all likely
0
1
2
3
4
5
6
7
8
9
Extremely likely
10
0 is Not at all likely, 10 is Extremely likely
What could we do to improve your experience?
If you would like us to follow up, please leave your email address (optional)
example@example.com
Submit Feedback
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