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Autobell Car Wash
Customer Feedback Form
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1. Your Contact Information
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First Name
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Last Name
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Account Number
Email
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Confirm Email
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Email Mismatch
Phone Number
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Full Address
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Street Number
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Address
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Apartment, Suite or Unit Number
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Continue to Step 2
2. Car Wash Search
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Specific Store Location - Feedback, questions, suggestions
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No Specific Store Location - Online Order, General Inquiry, feedback, questions, suggestions
Which Wash Did You Purchase?
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Ride-Thru With No Wipe-Down
Outside Wash Only
Outside Wash & Inside Cleaning
No Service Purchased
When did you visit our Auto Bell?
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Date:
Visit Date
Time:
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Continue to Step 3
3. Tell us about your experience, request or suggestion *
Select an item from the list below to tell us about your experience, request or suggestion. This is required.
Select an item from the list below to tell us about your experience, request or suggestion. This is required.
Commercial/Business Accounts
Question about my Gift Card/Coupon
Request for additional information
Wonderful experience
I have a concern
Locate missing/lost item
Alert or safety concern
Telephone issues
I have a suggestion
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Please provide all Required information on this page.
Continue to Step 4
3b. Tell us about your experience, request or suggestion *
Select an item from the list below to tell us about your experience, request or suggestion. This is required.
Select an item from the list below to tell us about your experience, request or suggestion. This is required.
Commercial/Business Accounts
Question about my Gift Card/Coupon
Request for additional information
Wonderful experience
I have a concern
Locate missing/lost item
Alert or safety concern
Telephone issues
I have a suggestion
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Required
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Required
Required
Required
Required
Please provide all Required information on this page.
Continue to Step 4
3c. Tell us about your experience, request or suggestion *
Select an item from the list below to tell us about your experience, request or suggestion. This is required.
Select an item from the list below to tell us about your experience, request or suggestion. This is required.
Commercial/Business Accounts
Question about my Gift Card/Coupon
Request for additional information
Wonderful experience
I have a concern
Locate missing/lost item
Alert or safety concern
Telephone issues
I have a suggestion
Required
Required
Required
Required
Required
Required
Required
Please provide all Required information on this page.
Continue to Step 4
3d. Tell us about your experience, request or suggestion *
Select an item from the list below to tell us about your experience, request or suggestion. This is required.
Select an item from the list below to tell us about your experience, request or suggestion. This is required.
Commercial/Business Accounts
Question about my Gift Card/Coupon
Request for additional information
Wonderful experience
I have a concern
Locate missing/lost item
Alert or safety concern
Telephone issues
I have a suggestion
Required
Required
Required
Required
Required
Required
Required
Please provide all Required information on this page.
Continue to Step 4
3e. Tell us about your experience, request or suggestion *
Select an item from the list below to tell us about your experience, request or suggestion. This is required.
Select an item from the list below to tell us about your experience, request or suggestion. This is required.
Commercial/Business Accounts
Question about my Gift Card/Coupon
Request for additional information
Wonderful experience
I have a concern
Locate missing/lost item
Alert or safety concern
Telephone issues
I have a suggestion
Required
Required
Required
Required
Required
Required
Required
Please provide all Required information on this page.
Continue to Step 4
4. Please Answer the Following:
Was a claim report completed with the location?.
Was a claim report completed with the location? .
Was a claim report completed with the location?
*
Select an Answer
Yes
No
Required
If Yes, what is the claim number?.
If Yes, what is the claim number? .
If Yes, what is the claim number?
*
Required
Answer must be less than 2000 characters
What was the Team Member's name?.
What was the Team Member's name? .
What was the Team Member's name?
Answer must be less than 2000 characters
How would you like to be contacted?.
How would you like to be contacted? .
How would you like to be contacted?
*
Select an Answer
Call
Email
Required
On what date did you place the order?.
On what date did you place the order? .
On what date did you place the order?
*
Required
Answer must be less than 2000 characters
Do you need a new card issued? (if so, the following questions must be answered).
Do you need a new card issued? (if so, the following questions must be answered) .
Do you need a new card issued? (if so, the following questions must be answered)
*
Select an Answer
Yes
No
Required
Please enter the FIRST and LAST NAME on Annual Pass or Super Card.
Please enter the FIRST and LAST NAME on Annual Pass or Super Card .
Please enter the FIRST and LAST NAME on Annual Pass or Super Card
*
Required
Answer must be less than 2000 characters
Please enter the STREET ADDRESS tied to the Annual Pass or Super Card.
Please enter the STREET ADDRESS tied to the Annual Pass or Super Card .
Please enter the STREET ADDRESS tied to the Annual Pass or Super Card
*
Required
Answer must be less than 2000 characters
Please enter the CITY on the Annual Pass or Super Card.
Please enter the CITY on the Annual Pass or Super Card .
Please enter the CITY on the Annual Pass or Super Card
*
Required
Answer must be less than 2000 characters
Please enter the STATE on the Annual Pass or Super Card.
Please enter the STATE on the Annual Pass or Super Card .
Please enter the STATE on the Annual Pass or Super Card
*
Required
Answer must be less than 2000 characters
Please enter the ZIP CODE tied to the Annual Pass or Super Card.
Please enter the ZIP CODE tied to the Annual Pass or Super Card .
Please enter the ZIP CODE tied to the Annual Pass or Super Card
*
Required
Answer must be less than 2000 characters
Please enter the TELEPHONE NUMBER tied to the Annual Pass or Super Card.
Please enter the TELEPHONE NUMBER tied to the Annual Pass or Super Card .
Please enter the TELEPHONE NUMBER tied to the Annual Pass or Super Card
*
Required
Answer must be less than 2000 characters
Please enter the EMAIL ADDRESS tied to the Annual Pass or Super Card.
Please enter the EMAIL ADDRESS tied to the Annual Pass or Super Card .
Please enter the EMAIL ADDRESS tied to the Annual Pass or Super Card
*
Required
Answer must be less than 2000 characters
Please enter the YEAR of your VEHICLE tied to the Annual Pass or Super Card.
Please enter the YEAR of your VEHICLE tied to the Annual Pass or Super Card .
Please enter the YEAR of your VEHICLE tied to the Annual Pass or Super Card
*
Required
Answer must be less than 2000 characters
Please enter the MAKE of your VEHICLE tied to the Annual Pass or Super Card.
Please enter the MAKE of your VEHICLE tied to the Annual Pass or Super Card .
Please enter the MAKE of your VEHICLE tied to the Annual Pass or Super Card
*
Required
Answer must be less than 2000 characters
Please enter the MODEL of your VEHICLE tied to the Annual Pass or Super Card.
Please enter the MODEL of your VEHICLE tied to the Annual Pass or Super Card .
Please enter the MODEL of your VEHICLE tied to the Annual Pass or Super Card
*
Required
Answer must be less than 2000 characters
Please enter the LICENSE TAG NUMBER tied to the Annual Pass or Super Card.
Please enter the LICENSE TAG NUMBER tied to the Annual Pass or Super Card .
Please enter the LICENSE TAG NUMBER tied to the Annual Pass or Super Card
*
Required
Answer must be less than 2000 characters
Please enter the STATE on your LICENSE TAG on your VEHICLE tied to the Annual Pass or Super Card.
Please enter the STATE on your LICENSE TAG on your VEHICLE tied to the Annual Pass or Super Card .
Please enter the STATE on your LICENSE TAG on your VEHICLE tied to the Annual Pass or Super Card
*
Required
Answer must be less than 2000 characters
What was the amount charged?.
What was the amount charged? .
What was the amount charged?
*
Required
Answer must be less than 2000 characters
Is it ok for us to contact you via text message? (this may incur a fee from your phone carrier).
Is it ok for us to contact you via text message? (this may incur a fee from your phone carrier) .
Is it ok for us to contact you via text message? (this may incur a fee from your phone carrier)
*
Select an Answer
Yes
No
Required
What is your Order Number?.
What is your Order Number? .
What is your Order Number?
*
Required
Answer must be less than 2000 characters
Has this issue occurred multiple times with your unlimited plan?.
Has this issue occurred multiple times with your unlimited plan? .
Has this issue occurred multiple times with your unlimited plan?
*
Select an Answer
Yes
No
Required
What were the last 4 digits of the card used for this charge?.
What were the last 4 digits of the card used for this charge? .
What were the last 4 digits of the card used for this charge?
*
Required
Answer must be less than 2000 characters
Did you visit a store location and your situation was not resolved?.
Did you visit a store location and your situation was not resolved? .
Did you visit a store location and your situation was not resolved?
*
Select an Answer
Yes
No
Required
Please give the name on the Debit/Credit Card used.
Please give the name on the Debit/Credit Card used .
Please give the name on the Debit/Credit Card used
*
Required
Answer must be less than 2000 characters
Please provide your Unlimited Plan/Card number..
Please provide your Unlimited Plan/Card number. .
Please provide your Unlimited Plan/Card number.
*
Required
Answer must be less than 2000 characters
Please give the Date of the Charge.
Please give the Date of the Charge .
Please give the Date of the Charge
*
Required
Answer must be less than 2000 characters
Please give the Amount Charged:.
Please give the Amount Charged: .
Please give the Amount Charged:
*
Required
Answer must be less than 2000 characters
Please give the Date the charge posted to your account.
Please give the Date the charge posted to your account .
Please give the Date the charge posted to your account
*
Required
Answer must be less than 2000 characters
Please give the last 4 digits of the Credit Card.
Please give the last 4 digits of the Credit Card .
Please give the last 4 digits of the Credit Card
*
Required
Answer must be less than 2000 characters
Please give the Last Billing Date:.
Please give the Last Billing Date: .
Please give the Last Billing Date:
*
Required
Answer must be less than 2000 characters
Please provide all Required information on this page.
Continue to Step 5
5. Please provide additional details about your experience *
Describe your Experience. This is a required field.
Describe your Experience. This is a required field.
Required
2000 characters available
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