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* 1. What was the date and time of your visit

Date / Time

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* 2. What was the purpose of your visit

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* 3. Were you able to get everything that you needed?

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* 4. What dollar amount did you spend during this visit?

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* 5. What was your method of payment

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* 6. Were you satisfied with your visit

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* 7. Do you have any comments about your visit?

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* 8. Please enter your contact information

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