Local Store Delivery or Pickup Preference Survey Form

Local Store Delivery or Pickup Preference Survey Form
Help us improve your experience by sharing your preferences for delivery or pickup at our local store.
Full Name
First NameLast Name
Preferred Contact Method
Email Address
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Which do you prefer?
What is the main reason for your preference?
If you chose delivery, what is your preferred delivery address?
Street Address
Street Address Line 2
CityState / ProvincePostal / Zip Code
If you chose pickup, which store location do you prefer?
What time of day do you usually prefer for delivery or pickup?
Any suggestions or feedback to help us improve our delivery or pickup service?
Should be Empty: