General Information

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Street Number:     Street Name:

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Customer Survey

What is your age group? Select-> 18 to 25 26 to 32 33 to 40 41 to 50 51 to 60 Over 61  

What is your annual gross income? Select-> 10 K 15 K 20 K 25 K 30 K 35 K 40 K 45 K 50 K 55 K 60 K 65 K 70 K 75 K 80 K 85 K 90 K 95 K Over 100 K

What is your level of education? Select-> Less than High School Completed High School Vocational School Some College Bachelor Degree Master Degree Phd

How did you heard about Us? Select-> Word of Mouth Webpage Business Card Internet Browsing Driving By Flyer Yellow Pages TV Add

How would you rate our food? Select-> Mediocre Average Above Average Excellent

How would you rate our cleanliness? Select-> Dirty Not that Dirty Average Clean Very Clean

How would you rate our prices? Select-> Low Somewhat Low Average Above Average High Extremely High

When would you be most likely to visit our restaurant? Select-> Sunday Monday Tuesday Wednesday Friday Saturday Sunday

During what season or seasons are you most likely to visit our restaurant? Select-> Holidays Summer Fall Winter Christmas Spring Other

During what period are you most likely to visit our restaurant? Select-> Breakfast Lunch Dinner To Go

Where would you like to see another Puerto Rico's Café?     

State:   City:

Would you come back to visit us & recommend our restaurant to family and friends? Select-> No Maybe Yes

Please fill out this box to inform us about other products and services that you would like us to offer:

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