Manager Input - Harveys

Name*

First Name Last Name

Email*

Comments

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Complete Questionnaire

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Date of Visit

Food Quality

Excellent	Good	Fair	Poor

Atmosphere

Excellent	Good	Fair	Poor

Hospitality

Excellent	Good	Fair	Poor

Service

Excellent	Good	Fair	Poor

Price Values

Excellent	Good	Fair	Poor

Cleanliness

Excellent	Good	Fair	Poor

Menu Variety

Excellent	Good	Fair	Poor

Overall Experience

Excellent	Good	Fair	Poor

Address

Street Address City State ZIP Code

Mobile Phone (e.g. #########)

Home Phone (e.g. #########)

Work Phone (e.g. #########)

Birth Month*

Birth Day*

Gender

Married?

Are you married?

Spouse First Name

First

Spouse Birth Month

Spouse Birth Day

Anniversary Month

Anniversary Day

Store ID

Store Address

Store Phone

Store Fax

Store Text-To

Store Text

Store Facebook

Store Twitter

Store Manager

Store Hours

Store Happy Hour

Birthday (Mailchimp)

Spouse Birthday (Mailchimp)

Anniversary (Mailchimp)

Address (Mailchimp)

Phone

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Starkville

Tupelo

Columbus

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Party Size

Date

Time

Starkville

Tupelo

Columbus

Choose Location

Party Size

Date

Time

Contact

Email Signup

Card Help

Comments

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Order Online

Columbus

Starkville

Tupelo