GENERAL INFORMATION  
1. Today's date (mm/dd/yy)
2. Which location did you visit?
3. Was this your first visit to a Jiffy Lube? Yes No
4. Was this your first visit to this particular location? Yes No
5. Did we discuss the manufacturer's recommendations? Yes No
6. Was our staff courteous and friendly? Yes No
7. Would you recommend this service to others? Yes No
If not, how come?
8. How would you rate the overall appearance of this location?
9. If you could describe your wait, would you say it was?
10. Did our Service Center Manager speak with you during your visit? Yes No
11. How long did you wait before we acknowledged you?
12. Please rate the payment process.
13. Did we escort you back to your vehicle after payment? Yes No
14. Did we place a reminder sticker on your windshield? Yes No
15. Did we thoroughly clean your exterior windows? Yes No
16. Did we thoroughly vacuum the interior of your vehicle? Yes No
17. Would you return to this location? Yes No
If not, how come?
18. Do you have any additional comments?
CONTACT INFORMATION  
Date Of Service (mm/dd/yy):
First Name:
Last Name:
Contact Number:
Vehicle Tag (please include state):
Email Address
Preferred Contact Method
If By Phone, The Best Time To Contact?
Would You Like To Enter The Drawing For A Free Oil Change? Yes No
   

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