Welcome to the Rubio's Guest Feedback Survey. We value your candid feedback and appreciate you taking the time to complete our survey.
Upon completion of this survey, you will receive a coupon code for a free drink or dessert with your next purchase.
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Please enter the following pieces of information from your receipt.
Store Number: InputStoreNum
Date of Visit: VisitDateMonth -- 010203040506070809101112 / Day -- 01020304050607080910111213141516171819202122232425262728293031 / Year -- 20222023
Time of Visit: Hour -- 010203040506070809101112 : Minute -- 000102030405060708091011121314151617181920212223242526272829303132333435363738394041424344454647484950515253545556575859 AM or PM -- AMPM