• Rate Your Shopping Experience

  • Thanks for your recent purchase!
  • Please complete the following survey for your chance to win a $100 Gift Certificate.
  • Please rate the following items.
  • 1 = very poor
  • 2 = poor
  • 3 = adequate
  • 4 = very good
  • 5 = excellent

STORE VISIT

  • Welcome Greeting
  • 1 2 3 4 5
  • Knowledge of Salesperson
  • 1 2 3 4 5
  • Friendliness of Staff
  • 1 2 3 4 5
  • Cleanliness of Store
  • 1 2 3 4 5
  • Overall Satisfaction
  • 1 2 3 4 5
  • Date of Visit *
  • What Store Did You Visit?
  • Fond du Lac
    Beaver Dam
    Watertown
    Warehouse Sale
  • We'd Like to ask you a few questions regarding the Delivery of Your Products (if applicable):

  • Timeliness of Delivery:
  • 1 2 3 4 5
  • Professionalism and Courteousness of Delivery Personel:
  • 1 2 3 4 5
  • Overall Satisfaction of Delivery and Installation:
  • 1 2 3 4 5
  • Comments:

    Which radio stations do you listen to?

  • KFIZ AM
  • K107 (107.1)
  • WMDC (The Great 98)
  • WTCX (96.1)
  • WFDL (97.7)
  • WXRO (95.3)
  • WBEV AM
  • The Fox (96.9)
  • WPKR (99.5)
  • iPod
  • XM
  • SIRIUS
  • Other

    Which newspapers do you read?

  • Action Advertiser
  • Action Shopper
  • Tri-County News
  • Beaver Dam Tri County
  • Dodge County Independent
  • Watertown Daily Times
  • Jefferson County Advertiser
  • FDL Reporter Online
  • FDL Reporter  ( Subscriber   Non-subscriber)
  • Dodge County Pioneer  ( Subscriber   Non-subscriber)
  • Other

    Which television stations do you watch?

  • ABC
  • CBS
  • NBC
  • FOX
  • HGTV
  • TLC
  • Lifetime
  • Weather Channel
  • History
  • Travel
  • Food Network
  • ESPN
  • CNBC
  • Fox News

    How do you prefer to learn of upcoming sales?

  • Radio
  • Newspaper
  • Shopper
  • TV
  • U.S. Postal Mail
  • Internet (Website or Email)

    May we use your comments as a testimonial in our marketing?

  • Yes    No

    Gender:

  • Male    Female

    Please tell us your age bracket:

  • Under 25
    26-34
    35-54
    55-64
    Over 64

Please enter your mailing address below so we may contact you if you win!

  • Name *
  • Address *
  • City *
  • State *
  • Zip *
  • Email *
  • Phone *
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