Vac Report - Test | QuestionPro

* Please enter your location's 3 digit numerical code (ex: Salina = 001).

* Please enter your location's 2 letter abbreviation (ex: Salina = SL).

* What type of counter is installed on the bay 1 vacuum?

Coin

Cycle

* Please enter the bay 1 BEGINNING counter number:

* Please enter the bay 1 ENDING counter number:

* Please enter the amount of the bay 1 deposit:

* Please select the appropriate response below:

I have finished entering the information for all of my vacuums.

I need to enter information for another vacuum, please.

* What type of counter is installed on the bay 2 vacuum?

Coin

Cycle

* Please enter the bay 2 BEGINNING counter number:

* Please enter the bay 2 ENDING counter number:

* Please enter the amount of the bay 2 deposit:

* Please select the appropriate response below:

I have finished entering the information for all of my vacuums.

I need to enter information for another vacuum, please.

* What type of coin counter is installed on the bay 3 vacuum?

Coin

Cycle

* Please enter the bay 3 BEGINNING counter number:

* Please enter the bay 3 ENDING counter number:

* Please enter the amount of the bay 3 deposit:

* Please select the appropriate response below:

I have finished entering the information for all of my vacuums.

I need to enter information for another vacuum, please.

* What type of coin counter is installed on the bay 4 vacuum?

Coin

Cycle

* Please enter the bay 4 BEGINNING counter number:

* Please enter the bay 4 ENDING counter number:

* Please enter the amount of the bay 4 deposit:

* Please enter any information the Home Office may need in order to properly reconcile your vacuum report (such are broken and/or replaced counters). Please specify which bay you are entering information for.