Southwest Grille
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1. What was the date of your visit? (mm/dd/yyyy)   / /

2. How would you rate your dining experience in the following areas?

Excellent Above Average Average Below Average Poor
Courtesy of the staff
Appearance of the staff
Speed of service
Cleanliness of the restaraunt
Quality of food
Value of your dining experience
The atmosphere and decor of the restaurant

3. Based on this visit would you return to dine with us again?   Yes No

4. Based on this visit would you recommend us to your friends?   Yes No

Contact Info:

Name : 
Address : 
City :   State :  Zip : 
Phone : 
E-Mail : 

  

Southwest Grille & Bar
12121 AnyStreet
Somewhere, MyState, 00000

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