First Name (required):

Last Name (required):

Email (required):

Mobile Phone Number:

Address:

City:

State: Select a State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

Zip:

Date of Visit:

Time of Visit:
Lunch
Dinner
Late Night

1. How often do you visit Oliver's?
   First Time
   Once a Week
   Once a Month
   Few Times a Year
   

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2. How did you hear about us today?
   Family or Friends
   Our signage / Marquis
   Radio
   Mail
   Internet
   Flyer
   Newspaper
   Yellow Pages
   Don't Know
   Other

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3. Why do you visit Oliver's? (Check all that apply)
   Atmosphere
   Martinis!
   Drink Selections
   Draft beer
   Menu Selections
   Food Quality
   Sports / TV's
   Service
   Other

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4. How did Oliver’s do?
   

   Food/Drink	Excellent	Good	Fair	Poor	N/A
   Food/Drink Menu Variety
   Quality of Food
   Quality of Drinks
   Presentation
   Overall

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   Service	Excellent	Good	Fair	Poor	N/A
   Attitude of Staff
   Promptness
   Accuracy of Order
   Overall

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   How did your server/bartender do? (Overall)
   Excellent
   Good
   Fair
   Poor
   N/A
   

   Server's / Bartender's Name:
   

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5. Would you recommend us?
   Yes
   No
   

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6. Do you plan on joining us again in the future?
   Yes
   No
   

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   (for #5 or #6 - If you answered no, we would love to know why)
   

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7. What did you like most about Oliver's??
   

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8. What would you like Oliver's to improve on?
   

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9. Are there any suggestions you would like us to consider adding to our food/drink menu?
   

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10. General Comments / Suggestions about restaurant and/or website.
    

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11. Please Tell Us About Yourself (Optional)

    Gender:
    Male
    Female
    

    Age:
    Under 20
    21-24
    25-29
    30-34
    35-44
    45-54
    55-64
    65 and up
    

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