Customer Care Feedback Form v 2.0

1
Customer Care Ticket #
2
What is your name?* This field is required.
First Name
Last Name
3
What is your email address?* This field is required.
example@example.com
4
What is your phone number?* This field is required.
Please enter a valid phone number.
5
Which store would you like to provide feedback on?* This field is required.
Alhambra - 151 N Garfield Ave
Anaheim - 2429 W Ball Road
Artesia - 12154 Artesia Blvd
Campbell - 330 E Hamilton Ave
Carrollton - 2540 Old Denton Road Ste 116
Cerritos - 20226 Pioneer Blvd
Chino Hills - 13920 City Center Drive Ste 4015
Chino Hills - 15911 Pomona Rincon Road Ste 100
Costa Mesa - 3033 Bristol St Ste L
Cupertino - 11111 Wolfe Road
Cypress - 9111 Valley View St Ste B
Downey - 8901 Apollo Way 4A
Durango - 6255 South Durango Dr
El Monte - 11968 Garvey Ave
Fountain Valley - 9475 Warner Avenue
Fountain Valley - 10065 Garfield Ave
Frisco - 9292 Warren Parkway
Fullerton - 505 N State College Blvd
Garden Grove - 9786 Westminster Avenue
Garden Grove - 13481 E Euclid Ste B
Garden Grove - 12002 Harbor Blvd
Houston - 9798 Bellaire Blvd Ste B
Houston - 3825 Richmond Ave
Houston - 8910 Westheimer Road
Huntington Beach - 7225 Edinger Ave Ste J
Irvine - 1485 Jeffrey Road
Las Vegas - 3959 Spring Mountain Road
Las Vegas - 7795 S Rainbow Road Ste 100
Riverside - 1201 University Ave Ste 101
Rowland Heights - 1627 Fullerton Road
San Jose - 1743 Berryessa Road
San Jose - 375 Saratoga Ave
Santa Ana - 1700 East McFadden Ave
Torrance - 18547 S Western Avenue
Tustin - 13771 Newport Ave Ste 12
Westminster - 15491 Brookhurst St
6
What type of feedback would you like to share with us?* This field is required.
Customer service
Product quality
Order accuracy
Store environment
Mobile app
Hiring/employee
Other
7
Based upon your feedback, what would you rate us?* This field is required.
8
What is the specific issue with the app?
Missing Leaves
User account problems
App interface
Payment issue
9
Comments you would like to share.* This field is required.
Huge
Large
Normal
Small
Ok
Ok
10
Take a picture of your receipt
11
Mobile ID #* This field is required.8 digit ID number located under your Profile
12
Would you like us to contact you directly about this?
YESNO
13
Was the feedback addressed?
Yes
No
Pending
14
Department assigned to address feedback.
Operations
Marketing
Human Resources
IT
Facilities
Franchise
15
Feedback submitted via channel.
Web
Yelp
Google
LoyaltyPlant
Social media
Other
Should be Empty: