| Online Registration Form
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| * are required fields |
| First Name: |
*
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| Last Name: |
*
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| E-Mail: |
*
*please be sure to type in a valid e-mail address.
E-mail will be used to send you notification for any new promotions available to
you.
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| Re-Type E-Mail: |
*
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| City: |
Which market area do you live in?
* |
| Zip Code: |
* |
| Gender: |
* |
| Age: |
* |
| Ethnicity: |
* |
| Income: |
Approx. * annually |
| Frequent Store: |
Is the QuikTrip you most frequently shop closer to your home or your workplace?
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| Gasoline: |
How often do you purchase gasoline from QuikTrip?
* |
| Merchandise: |
How often do you purchase store merchandise from QuikTrip?
* |
| Fountain Drinks: |
How often do you purchase fountain drinks from QuikTrip?
* |
| Coffee: |
How often do you purchase coffee/cappuccino from QuikTrip?
* |
| Sandwiches/hot dogs: |
How often do you purchase sandwiches or hot dogs from QuikTrip?
* |
| Candy/snacks: |
How often do you purchase candy or snacks from QuikTrip?
* |
| Beer: |
How often do you purchase beer from QuikTrip?
* |
| Cigarettes: |
How often do you purchase cigarettes from QuikTrip?
* |
| Cigarette Brand: |
Which brand of cigarette do you purchase from QuikTrip?
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| Cigarette Notify: |
Do you wish to be notified about price offers on cigarettes?
Yes |
| Coupon: |
Do you wish to receive coupons for free or discounted items from QuikTrip?
Yes |
| QT Employee: |
Are you an employee of QuikTrip?
Yes |
| Job Opportunities: |
Would you like to receive email notification when QuikTrip is hiring?
Yes |
| Radio Surveys: |
Would you like to participate in QuikTrip radio commercial surveys?
Yes |
