Customer Feedback Form for K&W; Cafeterias, Inc.
Title/Prefix
*
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Mr.
Mrs.
Miss
Ms.
Dr.
First Name
*
Last Name
*
Address
City
State
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Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip
Phone Number
*
Email Address
*
K&W Location Visited
*
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None
Asheboro, NC
Bluefield, WV
Burlington, NC
Charlotte - Independence Blvd
Charlotte - Pinnacle Dr
Cherry Grove, SC
Clemmons, NC (K&W; Cafe)
Concord, NC
Cornelius, NC
Fayetteville, NC
Goldsboro, NC
Greensboro - Holden Rd
Greensboro - Signature Place
Greenville, NC
Greenville, SC
High Point - Oak Hollow Mall
High Point - Westchester
Myrtle Beach - North
Myrtle Beach - South
Murrells Inlet, SC
Norfolk, VA
Raleigh - Cameron Village
Roanoke - Tanglewood
Roanoke - Crossroads
Rocky Mt., NC
Salem, VA
Salisbury, NC
Statesville, NC
Wilson, NC
Wilmington, NC
Winston Salem - Hanes Mill
Winston Salem - Healy Dr
Winston Salem - Peters Creek
Time of Visit
*
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None
Breakfast
Lunch
Dinner
Date of Visit
*
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DD
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25
26
27
28
29
30
31
YYYY
2012
2013
2014
2015
Feedback Type
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Compliment
Suggestion
Question
Complaint - Food
Complaint - Service
Complaint - Sanitation
Other
Comments
Preferred Method of Contact
*
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Email
Phone