Please enter the following pieces of information from your receipt.
Location Number: # Input the Location Number
Date of Visit: VisitDate
Time of Visit: Hour -- 010203040506070809101112 : Minute -- 000102030405060708091011121314151617181920212223242526272829303132333435363738394041424344454647484950515253545556575859 Meridiem -- AMPM
Upon completion of this survey, you will be given a validation code that can be used to redeem $5.00 off your next visit.
Your online session will expire in
2:00
Your online session will expire in 2 minutes 0 seconds
Please click “Extend Session” to continue. Otherwise, your survey will time out and you will need to start over.
