First Name:
Last Name:
Address:
City:
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Zip Code:
Phone Number:
E-mail Address:
Birthday: Month January February March April May June July August September October November December Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
Store: Select a Location ----------------- Poplar Cordova Collierville
Ticket Number:
Server Name:
1) Were you greeted pleasantly and with a smile? Yes No
2) Did you find your food to be fresh, with a good flavor? Yes No
3) Did you find your food to be of adequate portions and a good value? Yes No
4) Were you thanked and/or invited to return? Yes No
Additional Comments:
