Ziggie's Café :: Online Survey

Please fill out the survey as completely as you can.
Only take this survey if you have eaten at a Ziggie's Café.

We appreciate your participation in this survey!

1. Which location did you visit?

South Campbell
North Glenstone
West Kearney
Republic
Nixa

2. What is the ticket number on your Ziggie's Café receipt?

3. What date did you visit?

4. What time of day did you visit?

5. How did you hear of Ziggie's Café?

Please list any sources you heard about Ziggie's Café from.
(Station/Show/Any details you can recall/etc.)

Television Programming:
Local Programming:
Radio Broadcasting:
Newspaper:
Magazine:
Internet:
Billboard Advertisement:
Trade Show:
Another Restaurant's Referral:
Other:

6. How often do you go out for a meal?

Daily
Weekly
Monthly
2-3 Times Per Week
2-3 Times Per Month

7. What time period do you usually eat out?

Morning
Afternoon
Evening
After Midnight

8. What days do you usually eat out?

Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday

9. What is your main criterion in choosing a restaurant?

Location
Type (family, chain, etc.)
Pricing
Type of food offered

10. What area do you live in?

Republic
Springfield
Ozark
Nixa
If Other Please List:

11. What is your favorite breakfast item?

12. What is your favorite lunch item?

13. What is your favorite dinner item?

14. What is your favorite soup?

15. What is your favorite dessert?

16. Do you enjoy espresso?

Yes No
17. If Yes, what is your preference in espresso:

18. What was your server's name?

19. Was this your first visit to Ziggie's Café?

Yes
No
1st Visit to this location

20. Please Rate your dinning experience:

	Poor	Great
A. Prompt & Friendly Greet?	1 2 3 4 5
B. Were you seated promptly?	1 2 3 4 5
C. Order Taken Promptly?	1 2 3 4 5
D. Server's Friendliness?	1 2 3 4 5
E. Server's Knowledge of Menu?	1 2 3 4 5
F. Refills on beverages?	1 2 3 4 5
G. Food delivered promptly?	1 2 3 4 5
H. Food quality?	1 2 3 4 5
I. Value of dining experience?	1 2 3 4 5

21. Your contact information:
(All contact information required to be eligible for the drawing.)

We will not share your personal information with anyone else.

A. Full Name:
B. E-mail Address:
C. Phone Number:	(xxx) xxx-xxxx
Mailing Address:
D. Address Line 1: (Street)
E. Address Line 2: (Ste. or Apartment #)
F. Address City:
G. Address State:
H. Address Zip Code:

22. Would you like to subscribe to our free email newsletter?
The newsletter contains special offers and valuable coupons.
You can always un-subscribe later if you wish.

Yes
No
If you select "Yes" you will be redirected to our brief email newsletter sign up page after completing this survey.

Ziggie's Café :: Online Survey

Please fill out the survey as completely as you can. Only take this survey if you have eaten at a Ziggie's Café.

Please fill out the survey as completely as you can.
Only take this survey if you have eaten at a Ziggie's Café.