May we share your feedback on our website? *

Ex.: "The service I experienced with Dispenser Shield was...." - John Smith, Owner of ABC Gas.

YES

YES, but I'd prefer to remain anonymous.

NO

Name (optional)

First Name

Last Name

Which area(s), if any, do you feel this product was excellent?

Please mark all that apply.

Ease of Use

Appearance

Function

Durability

Ease of Installation/Removal

None / Other (please describe below)

Which area(s), if any, do you feel could use improvement?

Please mark all that apply.

Ease of Use

Appearance

Function

Durability

Ease of Installation/Removal

None / Other (please describe below)

May we share your feedback on our website and/or other marketing materials? *

Ex: "After installing Dispenser Shield® on my pumps, my station..." - John Smith, Owner of ABC Gas

YES

YES, but I'd prefer to remain anonymous.

NO

Name

*required only for testimonials

First Name

Last Name

How easy is our website to use and find what you're looking for?

Very Easy

Easy

Somewhat Confusing

Very Difficult

May we share your feedback on our website? *

Ex: "Using the Dispenser Shield website was..." - John Smith, Owner of ABC Gas

YES

YES, but I'd prefer to remain anonymous.

NO

Name (optional)

First Name

Last Name