Convenience Store Gas Station Survey

General Information

Question Title

* 1. What age group best describes you?

<20

21-30

31-40

41-50

51-60

61+

Question Title

* 2. What is your gender?

Female

Male

Question Title

* 3. What best describes your daily commute (Check all that apply)?

I work from home

I commute to a local facility/business

I travel around the state by vehicle

I travel regionally by vehicle

Other (please specify)

Question Title

* 4. In what ZIP code is your home located? (enter 5-digit ZIP code; for example, 00544 or 94305)