NACS Independent Operator Survey

Instructions:
1. Information entered on this form should reflect data for retailers who operate one to three stores.
2. NACS is seeking information for a typical month based on a 12-month average beginning the month of January.
3. Please provide 12-month averages.

The deadline to submit data is April 18, 2017

Question Title

* In order to start the survey, please provide your contact information.

Respondent Name

Respondent Email Address

Company Name

Doing Business as

Question Title

* Store #1

Street address

City

Zip Code

State

Operating hours per day

Question Title

* Store #2

Street address

City

Zip Code

Operating hours per day

Question Title

* Store #3

Street address

City

Zip Code

Operating hours per day

Question Title

* Store #1

Urban/Metropolitan (50,000+)

Urban Cluster/ Suburban(2,500-49,999)

Rural (<2,500)

Other

Other (please specify)

Question Title

* Store #2

Urban/Metropolitan (50,000+)

Urban Cluster/ Suburban(2,500-49,999)

Rural (<2,500)

Other

Other (please specify)

Question Title

* Store #3

Urban/Metropolitan (50,000+)

Urban Cluster/ Suburban(2,500-49,999)

Rural (<2,500)

Other

Other (please specify)

8% of survey complete.