Fill Out the Survey Form Below

The survey/gas card is intended for those customer who have purchased a vehicle from us in the last 3 months.

* = required

How did you hear about Wild West Chevrolet? Did you visit our website before making your purchase?

Yes No

Did another website lead you to our site?

Yes No

If yes, Which one? What other, if any, websites did you visit prior to purchase? Where do you get your news? What social media sites do you use? What do you watch on TV? What tv services do you pay for, if any? What do you listen to in the car? If you listen to radio, what stations do you listen to?

You'll be entered into a quarterly drawing for a $150 gas card

First Name* Last Name* Email* Phone Number

IDHL7E

Joint Applicant's Information

Submit