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* Name:
Street Address: Unit#:
* City: * State: * Zip:
* E-Mail:
Birthday: Month Day Year
Anniversary Date: Month Day Year
Cell Cell Provider:
*Your Servers Name:
*Rate Your Server: Unacceptable 1 2 3 4 5 6 Outstanding
Rate Your Food: Unacceptable 1 2 3 4 5 6 Outstanding
Rate Our Menu: Unacceptable 1 2 3 4 5 6 Outstanding
Rate Restaurant Cleanliness: Unacceptable 1 2 3 4 5 6 Outstanding
Would you Refer a friend
to Chris & Mario's? 		Yes No
What did you order?
How many in your party? 1 2 3 4 5 6
Did you come in for: Appetizers Lunch Dinner
How often do you dine with us? 0 First Time 1-2 Times a month Once a week or more 1-4 times a year

* Comments: