Milan Center Feed & Grain

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First Name *
Last Name
Address *
City *
State *
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E-mail *
Phone *
How did you hear about us?	Newspaper Radio TV Facebook The yellow pages Billboard Ad Friend/Family Drive-By Other

Are you on our mailing list? If no, would you like to be added to our mailing list? (We do NOT share your information.)	YesNo
	YesNo
Are you on our email list? If no, would you like to be added to our mailing list? (We do NOT share your information!)	YesNo
	YesNo
Tell us about your pet(s)
Do you own small pets?	YesNo
Species
Current feed program:
Do you own large animals?	YesNo
Species
Current feed program:
Do you show your animals?	YesNo
Species
Current show feed:
Are you a wild bird lover?	YesNo
What do you feed?	Mixed Birdseed Shelled Corn Ear Corn Thistle (Nyjer) Sunflower Seeds/Pieces Safflower Peanuts Suet Meal Worms Other

How can we better serve you?
How would you rate your experience in our store? (5 being the best)	5 4 3 2 1 0(Never been in our store)
Comment
How would you rate our store's appearance? (5 being the best)	5 4 3 2 1 0(Never been in our store)
Comment
Have you used our drive thru loading area?	YesNo
How would you rate our drive thru service? (5 being the best)	5 4 3 2 1
Comment
Have you used our mill service?	YesNo
How would you rate our mill service? (5 being the best)	5 4 3 2 1
Comment
What products or services would you like to see us provide?
Would you like more information?	Livestock Feeds Show Feeds Pet Feed Exotic Animal Feeds Wild Bird/Wild Life Chick or Fish Days Animal Health Livestock Equipment Fences Pasture or Cover Crops Lawn & Gardens Pond Pesticides or Insecticides Services We Offer Other
What is the best way for us to contact you with more information?

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