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Name*	:
Email*	:
Phone*	:
Address*	:
Which Ziggie's Location did You Visit?*	:	Springfield: 4228 S. National Springfield: 2222 S. Campbell Springfield: 935 N. Glenstone Springfield: 1324 W. Kearney Joplin: 3320 S. Rangeline Rd. Marshfield: 1321 Spur Drive Nixa: 911 N Kenneth Republic: 1230 US HWY 60 Poplar Bluff: 2775 N. Westwood Blvd. West Plains: 1613 Porter Wagoner Blvd. Rolla: 1033 Kingshighway
Server Name*	:
Date of your visit*	:	1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
Is this your first visit?*	:	yes no
How did you hear about us?*	:	Friend Newspaper Walk-in Website Magazine Other
Overall Experience*	:	Excellent Good Average Fair Poor
Greeting by Hostess*	:	Excellent Good Average Fair Poor
Manager (Table Visit)*	:	Excellent Good Average Fair Poor Manager did not visit our table
Overall Service*	:	Excellent Good Average Fair Poor
Professionalism*	:	Excellent Good Average Fair Poor
Menu Knowledge*	:	Excellent Good Average Fair Poor
Friendliness*	:	Excellent Good Average Fair Poor
Menu Selection*	:	Excellent Good Average Fair Poor
Food Quality*	:	Excellent Good Average Fair Poor
Food Presentation*	:	Excellent Good Average Fair Poor
Value for $ Spent*	:	Excellent Good Average Fair Poor
Cleanliness of Restaurant*	:	Excellent Good Average Fair Poor Did not use the restrooms
Cleanliness of Restroom*	:	Excellent Good Average Fair Poor
Cleanliness of Exterior*	:	Excellent Good Average Fair Poor
What comments would you give us to improve our restaurant?*	:

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