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If you take our survey below, you will automatically be entered in our $100.00 Gift Card drawing.
 
Please enter your contact information:  (note: red fields are required)    
Name:
Address:
City:  State:   Zip: 
Phone:
FAX:
email:
 
By completing this entry form for our $100.00 Gift Card drawing, I agree to abide by the terms of the drawing set forth here.
     Yes
     No
 
Did you find everything that you were looking for?
     Yes
     No
 
If not, what would you like to see added?
    
 
How satisfied are you with your experience with the website?
     Very Satisfied
     Satisfied
     Neutral
     Dissatisfied
 
If neutral or dissatisfied, please explain why?
    
 
Where did you hear about our website?
     Search Engine (Google, Bing, ...)
     Another Website
     Magazine
     Email Advertisement
     Recommendation
     Other
 
If you placed an order, did you take advantage of the Free UPS Ground for orders over $300?
     Yes
     No
 
If you did not place an order, please explain why?
     Did not see what I wanted.
     Not sure what I need.
     Called in order.
     Price too high.
     Other   
 
How many gasoline/truckstop station(s) do you own or manage?
     1-5
     6-10
     11-25
     25+
     I do not own or manage.
     I do not own or manage but provide services/maintenance to station(s)
 
Would you be interested in receiving emails or flyers with "specials" and "promotions"?
     Yes
     No
 
Comments:
    
 
      

See the survey / contest rules here.
 
 
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