Prime Shine Express : Survey

Please take a few moments to tell us how we did.
Remember all items that have a highlighted title are required.

GENERAL INFO - STEP 1

Survey For

Car Wash

Lube

Sales Receipt #

(Must be 11 Digits)

Name

Phone Number

Address

City

State

Zip Code

Email Address

Gender

Male

Female

Age

16-25

26-35

36-50

Over 50

VEHICLE INFO - STEP 2

Make of Car

(example: Toyota)

Model of Car

(example: Camry)

Year of Car

QUESTIONNAIRE - STEP 3

How far do you drive to go to a Prime Shine Express location?

This survey refers to which location?

Cashier Name

Date of visit

Time of visit

Is this your first time through a Prime Shine Express?

Yes

What is the number one reason for coming to Prime Shine Express?

Other

How did you first hear about Prime Shine Express?

Other

	Excellent	Good	Average	Poor	N/A
Cleanliness of the facility:
Appearance of employees:
Attitude of employees:
Performance of vacuum:
Cleanliness of car:
Cleanliness of car's windows:
Cleanliness of car's wheels:
Effectiveness of spot free rinse:
Speed of Lube Service:
Quality of Lube Service:
Knowledge of Lube Techs

What do you remember most about your visit to Prime Shine?

How could we improve the service that we provide to you?