Customer Information Title Name* Street Address City State Postal Code Phone Number Email* Where did you hear about us?(Select all that apply) Internet Magazine Newspaper Word of Mouth Other What's your favourite dish? How many time do you dine out per month? Add me to your mailing list for great coupons and specials! Share your experience Date of Visit Order type Dine in Pick-up Delivery Was you service friendly? Yes No Was your order correct? Yes No was your food hot? Yes No Rate the overall service( 0 = poor; 10 = great )0 10 Tell us more about your experience!