Comment Card

1. Let us know how we did!

Thank you for taking the time to share about your Jubitz experience.

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1. Contact information (Required.)

Name *

Company

Address

Address 2

City/Town

State

ZIP

Email Address *

Phone Number

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2. When were you here?

Date

Time

AM/PM

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3. Please check (Required.)

Male

Female

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4. Please check (Required.)

CDL

Non-CDL

Live / work locally

Traveling through area

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5. Please rate the following

	Poor	Good	Excellent
Friendliness of staff	Friendliness of staff Poor	Friendliness of staff Good	Friendliness of staff Excellent
Speed of service	Speed of service Poor	Speed of service Good	Speed of service Excellent
Price / payment process	Price / payment process Poor	Price / payment process Good	Price / payment process Excellent
Menu and quality of food	Menu and quality of food Poor	Menu and quality of food Good	Menu and quality of food Excellent
Cleanliness	Cleanliness Poor	Cleanliness Good	Cleanliness Excellent

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6. What facilities/services did you use?

Jubitz Cinema

Marketplace Convenience Store

Gas station

Portlander Inn

Laundry

Ponderosa Lounge & Grill

Moe's Deli

Cascade Grill

Jubitz Truck Service Center

Driver Services Convenience Store

Jake Brake Deli

Fuel station

Free parking

Paid parking

Shower facilities

Truck scale

Security

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7. Overall rating of your experience (Required.)

0 - Poor

5 - Average

10 - Excellent

Clear

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

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* 1. Contact information (Required.)

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* 2. When were you here?

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* 3. Please check (Required.)

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* 4. Please check (Required.)

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* 5. Please rate the following

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* 6. What facilities/services did you use?

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* 7. Overall rating of your experience (Required.)

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* 8. Comments

1. Contact information (Required.)

2. When were you here?

3. Please check (Required.)

4. Please check (Required.)

5. Please rate the following

6. What facilities/services did you use?

7. Overall rating of your experience (Required.)

8. Comments