3#**id**#Do you ever plan to return to this store?#**label**#type_radio#****#4#**id**#Overall, please rate the quality of customer service that you received during this visit.#**label**#type_own_select#****#5#**id**#What were the main reasons for the poor quality of customer service? Please select all that apply.#**label**#type_checkbox#****#6#**id**#Did you file a formal complaint regarding the customer service?#**label**#type_radio#****#7#**id**#When was this complaint filed?#**label**#type_radio#****#8#**id**#Did anyone from the store follow-up with you about the complaint?#**label**#type_radio#****#9#**id**#Would you like a store representative to contact you?#**label**#type_radio#****#10#**id**#Were you satisfied with the follow-up to your complaint?#**label**#type_radio#****#11#**id**#Why werent you satisfied with the follow-up to your complaint?#**label**#type_textarea#****#12#**id**#What is the highest level of education that you have achieved?#**label**#type_radio#****#13#**id**#What was your household income last year?#**label**#type_radio#****#14#**id**#type_submit_reset_14#**label**#type_submit_reset#****#