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To begin, please enter the 18-digit survey code and visit time located near the bottom of your receipt.

Input digits 1-4 of survey code - Input digits 5-14 of survey code - Input digits 15-18 of survey code

Time: Hour -- 010203040506070809101112 : Minute -- 000102030405060708091011121314151617181920212223242526272829303132333435363738394041424344454647484950515253545556575859   Meridiem -- AMPM

I do not have an 18-digit code on my receipt.

Upon completion of this survey, you will be given an validation code that can be used to redeem the offer printed on your survey invitation.