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* 1. Enter your shop name

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* 2. What month are you reporting for? 

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* 3. Number of customers who received a free visual leak inspection. (Please answer with a numeric value only)

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* 4. Number of customers with a leak detected during the free visual leak inspection. (Please answer with a numeric value only)

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* 5. Number of leaks repaired. (Please answer with a numeric value only)

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* 6. Please provide your contact information, so that we can reach you in case we have questions about your answers.

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