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Your Experience
Contact Information
Name:
Phone:
Email:
Contact Address
Street:
City:
State/Province:
Zip/Postal Code:

Visit Information
Date Visited:
Approximate Time of Visit:
Did you visit with:
Are you here because of a promotional program?
If so, which one?
Are you a returning customer from a specific promotional program?

Rating System
How would you Rate our Service?
How would you Rate Our Food?
How did you like our Atmosphere?
How would you Rate Our Establishment Overall?

Additional Information
How often are you a regular customer at Brady's Tavern?
When is our business birthday with you? (when did you become a customer?)
 

Additional Information: