RECEIPTS FROM CONSUMERS

We kindly request that you take a moment to fill out this survey. Your feedback is valuable to us and will assist in enhancing our services.

Question Title

1. Name of customer (Required.)

Question Title

2. Please list your email address

Question Title

3. Please provide your phone number

Question Title

4. Please list the establishment attended

Question Title

5. Please provide the date attended

Date

Date

Question Title

6. Please upload a screenshot of the bill

Question Title

7. How happy were you?

0

5

10

Clear

i We adjusted the number you entered based on the slider’s scale.

Question Title

8. Please provide any additional comments