CUSTOMER FEEDBACK

Extreme Pita is only as good as its customers. Your comments, concerns and suggestions help us in our quest to provide a continuous positive pita experience. Please fill out the form below.

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Extreme Pita Location:

Server Name:

Date:

Time of Visit:

Lunch

Dinner

Late Evening

How do you rate our service? (Please check appropriate box)

Excellent

Good

Average

Disappointing

Friendly

Attentive

Prompt

Informed

How would you rate the following? (Please check appropriate box)

Excellent

Good

Average

Disappointing

Cleanliness

Food Quality

Value

Atmosphere

How often do you visit Extreme Pita?

Weekly

Monthly

Occasionally

First Time

Comments:

Personal Information:

To help maintain a high level of customer satisfaction, we require the following fields be completed. You could be contacted by an Extreme Pita head office representative regarding your feedback.

*First Name:**	*Last Name:**	*Email:**

Telephone:	*Address:**	*City:**

*Province / State:**	*Postal Code/Zip Code:**

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