Personal Information
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First Name
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Last Name
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Phone
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Email
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Store Location
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Street, City, State
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Survey Questions
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1. How often do you shop at a convenience store?
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1 time per week
Several times per week
Less than 4 times per month
Almost never
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2. How often is Super Quik the convenience store you shop?
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Almost all the time - more than 75%
Only occasionally 25 - 50%
50 - 75% of the time
Rarely - Less than 25% of the time
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3. What is the most likely time for you to shop convenience
stores?
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6am to 11am
11am to 3pm
3pm to 7pm
7pm to midnight
Midnight to 6am
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4. Please check any items you purchase regularly when shopping
convenience stores.
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(hold down "Ctrl" key to select multiple items)
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5. What is the most likely reason you choose a particular convenience
store other than convenience or location?
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Friendliness of employees
Price of Fuel
Particular products they offer
Exterior / interior decor appearance
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6. Does our monthly advertising program (exterior, interior
signage with discounts) help you purchase a particular item or
any additional items?
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Yes
No
Not Sure
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7. How would you rate Super Quik on cleanliness of our store,
considering parking lot, restrooms, sales floor, and foodservice
area?
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Very Clean
Clean
Fair
Poor
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8. How does Super Quik rank with other convenience stores in
this geographic area?
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Much better
Comparable
Not as good
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9. Do you feel Super Quik consistently has products in stock
and available to purchase as you need them?
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Yes
No
Usually
No opinion
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10. How do you feel Super Quik ranks with our competition in
this area on gasoline price, quality, and fuel dispensing equipment?
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Much better
About the same
Not as good
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11. Are there any products / services Super Quik does not carry
that you would like to see us handle?
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12. How can we serve you better?
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May we email you about promotions and special offers?
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Yes
No
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