Sample survey: Grocery Store Customer

Customer Satisfaction Survey

XXX Superstore

Note: Marked with * is required.

Section 1

1.1

How would you rate our store in term of...

	Excellent	Very good	Average	Fair	Poor
Courtesy and Service:
Store Cleanliness:
Selection and Variety:
Produce Quality/Freshness:
Meat Quality/Freshness:
Dairy Quality/Freshness:
Bakery Quality/Freshness:
Regular Prices:
Readability off Price Tags:

1.2

How can we better serve you?

Section 2

2.1

What is your gender? *

Male

Female

2.2

What is your age? *

2.3

What is your annual household income? *

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