Name (required)

Address

City

State
ALAKAZARCACOCTDEDCFLGAHIIDILINIAKSKYLAMEMDMAMIMNMSMOMTNENVNHNJNMNYNCNDOHOKORPARISCSDTNTXUTVTVAWAWVWIWY

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Home Phone

Work Phone

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Tell us about your visit

Date of Visit

Time of Visit

Reason for Visit
---LunchDinnerSpecial Event

Service

Friendliness of Host Staff

 Poor Good Outstanding

Friendliness of Server

 Poor Good Outstanding

Attentiveness of Staff

 Poor Good Outstanding

Food

How was the flavor of your meal?

 Poor Good Outstanding

Did you receive good value?

 Poor Good Outstanding

Was the temperature of the food what you expected?

 Poor Good Outstanding

Did you take any Home?

 Yes No

Beverages

How was your Margarita?

 Poor Good Outstanding

Was your beer cold?

 Yes No

Did you have enough selections to choose from?

 Yes No

Were refills delivered in a timely fashion?

 Yes No

Overall

How would you rate your visit?

 Poor Good Outstanding

Was a Manager Visible?

 Yes No

Did the Manager visit your table?

 Yes No

Did we "WOW" you?

 Yes No

Additional Comments, Please feel to express your enthusiasm here!

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