75%
Questions marked with a * are required Exit Survey
 
Contact Information
* Marketer Name : 
Marketer Sold To# : 
CITGO Location # : 
* First Name : 
* Last Name : 
* Phone : 
* Email Address : 
 
 
 
Please tell us how you’ve been Fueling Good in your community during these tough times. 
 
 
 
* Who are you supporting? (i.e. general public, customers, first responders, specific organization, etc.) 
   
 
 
 
* What are you providing? (i.e. funds, food, discounts, etc.)
   
 
 
 
* What do you estimate is the monetary value (if applicable) or estimated amount raised? 
   
 
 
 
* Did you get local media coverage? (i.e. newspaper article, news spot, etc.)
 
Yes
 
No
 
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