* 1. What is your name?

* 2. Date of visit?

Date of visit?

* 3. Would you like to be added to our e-mail list?

* 4. What is your email address?(optional)

* 5. What was your server's name?

* 6. To help provide us with quality food and service, would you please rate us on the following areas

  Poor Keep Trying Good Very Good "Wicked Good"
Friendliness of Your Server
Promptness of Your Server
Quality of Your Meal
Value of Your Meal

* 7. Any Additional Comments?