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First Name	*			How often do you eat out?	Less than once a week Once a week Twice a week More than twice a week
Last Name	*			Do you prefer to receive?	Direct mail coupons In store offers Newspaper coupons
Street Address				What are your two favorite restaurants?
City				Which restaurant location are you sending feedback for?	Indpls - W. Rockville Rd. Indpls - Crawfordsville Rd. Indpls - US 31 South Columbus, IN Kokomo, IN Lafayette, IN

State	AK AL AR AZ CA CO CT DE FL GA HI IA ID IN IL KS KY LA MA MD ME MI MN MO MS MT NC NE NH NJ NM NV NY ND OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY	Zip		When did you eat there?
e-Mail Address	*			What are your favorite foods when eating out?
Gender	M		F
Birthday	/ /			When you go to dinner, what else do you do that night?
Anniversary	/ /			What is your favorite dinner?
Age				How did you learn about this website?
Special comments or requests?
Thank you for taking the time to complete this survey.