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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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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:
Hour
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08
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Minute
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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 a plan, pass or coupon
Request for additional information
Wonderful experience
Unpleasant experience
Locate missing/lost item
Alert or safety concern
Telephone issues
I have a suggestion
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3b. Tell us about your experience, request or suggestion *
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Select an item from the list below to tell us about your experience, request or suggestion. This is required.
Commercial/Business Accounts
Question about a plan, pass or coupon
Request for additional information
Wonderful experience
Unpleasant experience
Locate missing/lost item
Alert or safety concern
Telephone issues
I have a suggestion
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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 a plan, pass or coupon
Request for additional information
Wonderful experience
Unpleasant experience
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
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 a plan, pass or coupon
Request for additional information
Wonderful experience
Unpleasant experience
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
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 a plan, pass or coupon
Request for additional information
Wonderful experience
Unpleasant experience
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
4. Please Answer the Following:
Was a report completed?.
Was a report completed? .
Was a report completed?
*
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
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 is your Order Number?.
What is your Order Number? .
What is your Order Number?
*
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 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 Select the Unlimited Plan Type:.
Please Select the Unlimited Plan Type: .
Please Select the Unlimited Plan Type:
*
Select an Answer
Exterior Unlimited
Full Service Unlimited Plan
Super Unlimited
Required
Please give the Amount Charged:.
Please give the Amount Charged: .
Please give the Amount Charged:
*
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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
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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:
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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.
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