2. ruralTRANSIT CUSTOMER FEEDBACK FORM

4. ruralTRANSIT strives to provide excellent customer service and values customer feedback. Please use this form to to give us your suggestions, compliments, or complaints.

6. THIS FEEDBACK IS A: *

   1. Suggestion

   1. Compliment

   1. Complaint
8. EVENT DETAILS

   Please provide the details behind your suggestion, compliment or complaint. 

10. Details*
12. Date/Time
    Date/Time

    Date/Time
13. Route Number
    -- Select One --234
14. Driver Name
16. CONTACT INFORMATION

    Please provide contact information so we may follow up as needed.

18. First Name*
19. Last Name
21. Mailing Address
23. City
24. State
25. Zip
27. Phone
28. Email*
Leave This Blank:


30. 1. Receive an email copy of this form.
31. Email address

    This field is not part of the form submission.

32. Submit Submit and Print

* indicates a required field