Welcome to the CC's Coffee House Guest Satisfaction Survey. We value your candid feedback and appreciate you taking the time to complete our survey.

Please enter the following pieces of information from your receipt.

3-digit Store Number: InputStoreNum

Date: VisitDateMonth -- 010203040506070809101112 / Day -- 01020304050607080910111213141516171819202122232425262728293031 / Year -- 2425

Time: Hour -- 010203040506070809101112 : Minute -- 000102030405060708091011121314151617181920212223242526272829303132333435363738394041424344454647484950515253545556575859   Meridiem -- AMPM

Amount Spent: AmountSpent1 . AmountSpent2

Order ID/Check Number (optional): InputOrderID