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* 2. Date of most recent visit to myAGWAY shop.

Date / Time

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* 3. How likely are you to recommend myAGWAY to a family member or friend?

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* 4. How satisfied are you with your overall experience at myAGWAY?

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* 5. Based on your recent experience, please rate your satisfaction with the friendliness of the staff:

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* 6. Based on your recent experience, please rate your satisfaction with the ability of our staff to answer your questions.

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* 7. Based on your recent experience, please rate your satisfaction with the ease at which you could find what you were looking for.

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* 8. Is there a product you would like to see myAGWAY carry? (Please indicate as many as you would like.)

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* 9. Including this visit, how many times have you shopped at myAGWAY in the past 6 months?

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* 10. Which product departments do you shop at myAGWAY? (check all that apply)

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* 11. Please indicate your gender.

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* 12. Please indicate your age group.

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* 13. Please enter any additional comments you would like to share about your shopping experience at myAGWAY.

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* 14. Please enter your contact information below to receive a Thank You Coupon for $5 off your next $30 purchase, and be entered into myAGWAY's $250 Gift Card Sweepstakes. (All fields are required. A valid email is necessary to receive your $5 thank you gift)

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* 15. I would like to receive myAGWAY offers and specials via email.

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