Kum & Go Survey

Recent Sweepstakes Winners

April 2012 - Regeina from Springfield, MO
March 2012 - Susan from West Des Moines, IA
February 2012 - Kathryn from Carthage, MO
January 2012 - Larry from Ankeny, IA
December 2011 - Amy from Sioux Falls, SD
November 2011 - Henry from Thornton, CO
October 2011 - Greg from Ankeny, IA
September 2011 - Tim from Waterloo, IA
August 2011 - Richard from Bentonville, AR
July 2011 - Amanda from Muskogee, OK
June 2011 - Teresa from Owasso, OK
May 2011 - Jimmy from Sand Springs, OK

We appreciate you taking a few minutes to tell us about your recent Kum & Go experience.

These surveys are very important and are reviewed by all levels of the Kum & Go organization. Your honest and candid answers will be used to make Kum & Go even better for you.

For no purchase necessary entries: the entrant must send a letter including the entrant's full name, date of birth, mailing address, and telephone number to: Kum & Go Customer Survey Sweepstakes, Attention: RBW, 6400 Westown Parkway, West Des Moines, Iowa 50266. Mail-in entries must be received by Sponsor no later than two (2) business days prior to the date on which the entrant's sweepstakes entry is deemed to be entered for the applicable sweepstakes period. One entry per household per day. For information regarding the contest rules and our privacy policy please visit www.kumandgo.com/survey-rules.

* - Required Fields

Please enter your 12 digit code as it appears on your Kum & Go Receipt. (Please do not use punctuation or spaces) *

Which of the following age categories best describes you? *
Less than 14 years old
14-17
18-24
25-34
35-44
45-54
55-64
65+
What is your gender? *
Male
Female
Prefer not to respond
Did you buy fuel today? *
Yes, I paid at the pump
Yes, I paid inside
No
How likely is it that you would recommend Kum & Go to a friend or colleague? *

Not likely at all

Extremely likely

Please rate the following based on today's experience

How would you rate the cleanliness? *
12345678910

Does not meet
expectations

Exceeded
expectations

How would you rate the ease and speed of the shopping experience? *
12345678910

Does not meet
expectations

Exceeded
expectations

What is the primary item you came to purchase today (listed alphabetically)? *
Beer / wine / liquor
Bottled Drink (nonalcoholic)
Breakfast items
Cigarettes / tobacco products
Coffee / cappuccino / hot chocolate
Fountain Drink
Fuel
Lottery Ticket
Milk (gallon)
Newspaper
Prepared food / Deli (pizza, sandwiches, roller grill, etc.)
Snacks / Chips / Candy
Other / Grocery / Auto Supplies
How often do you visit this Kum & Go store? *
1 or more times per day
2 or more times a week
Once a week
Less than weekly
First time visiting this Kum & Go
Please note additional details regarding this visit. *

What can we do to improve your next Kum & Go Experience? *

Full Name *
Address *
City *	State *
Zip Code *
Phone Number * () -
Email Address *

Do you wish to receive future promotional emails from Kum & Go *
Yes
No