First Name	Last Name
Street Address
City	State	Zip
Phone	Email
() -

How did you learn about this site?		Referral / Friend Print Ad Radio Ad Search Engine Customer Service Other
	If Other, please specify:

Please rate the FifthAvenuePlacePA.com website:
		Scale: 1-Poor...5-Excellent
		1	2	3	4	5
Site Look and Feel
Ease of Use
Informational Content
Site Navigation

What would you like to see improved or added to FifthAvenuePlacePA.com?

Have you ever visited Fifth Avenue Place?  Yes No
	Why or why not?

What is most important to you when shopping?
	Scale: 1-NOT Important...5-VERY Important
			1	2	3	4	5
Price
Service
Selection
Convenience
Product Quality
Incentives / Promotions