RECEIPTS FROM CONSUMERS

We kindly request that you take a moment to fill out this survey. Your feedback is valuable to us and will assist in enhancing our services.

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* 1. Name of customer

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* 2. Please list your email address

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* 3. Please provide your phone number

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* 4. Please list the establishment attended

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* 5. Please provide the date attended

Date

Date

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* 6. Please upload a screenshot of the bill

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.

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* 7. How happy were you?

0

5

10

Clear

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

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* 8. Please provide any additional comments