Customer Feedback Form Please let us know about your experience at Chick-fil-A, Surprise Marketplace, by completing the following: Excellent Good Poor How would you rate your visit? 5 4 3 2 1 Food 5 4 3 2 1 Service 5 4 3 2 1 Cleanliness 5 4 3 2 1 Comments/Suggestions: Date: Time: a.m. p.m. Employee Who Served You: Your Name: Address: City: State: Zip: Phone: Email:

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