Location:
Name:  
Address:
City:
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Home Phone:
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Tell us about your visit

Date of Visit:
Time of Visit:
Reason for Visit: 

Service

 Poor Good Outstanding
Friendliness of Host Staff
Friendliness of server
Attentiveness of Staff

Food

 Poor Good Outstanding
How was the flavor of your meal?
Did you receive good value?
Was the temperature of the food what you expected?
Did you take any Home? Yes No

Beverages

 Poor Good Outstanding
How was your Margarita?
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

Over All

 Poor Good Outstanding
How would you rate your visit?
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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