Rib City Survey

Help us to improve our restaurant by answering a few questions and we will send you a coupon for a complimentary appetizer at the Rib City Grill of your choice!

** REQUIRED	All information must be current and valid

** Name
** Address
Address Cont.
** City
** State
** Zip
** Telephone
** E-Mail
**Age
**	Male Female
**Date of last visit
Server's name
**Location
**What is your favorite Rib City entree:
How can we improve:	(If you have encountered a problem, please include date and time even occurred.)

**1=Low and 5=High
How would you rate our food quality?	1 2 3 4 5
How would you rate our service?	1 2 3 4 5
How would you rate your overall opinion of Rib City?	1 2 3 4 5
How would you rate your value for your money?	1 2 3 4 5

To help prevent spam, please answer the following: What is the total of 10 + 5: Please confirm your answer: