EmailMe Form - Buffalo's Feedback

Location *

Select One

Date of Visit *
MM / DD / YYYY HH : MM AM/PM
Feedback Regarding *
Recent Visit
Marketing - Promotion
Food Related
Feedback Concerning *
Dine - In
Take - Out
Drive - Thru
Other
Details About Experience *
I had a wonderful experience
I had an unpleasant experience
I have a suggestion
Name *
First Last
Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region
Email *
mail@example.com
Phone
### - ### - ####
How likely is it you would recommend us to a friend?

Not at all likely
1

2

3

4

5

6

7

8

9

10

Extremely likely
Why?
Do you live in the area? *
1-2 miles
3-4 miles
5+ miles
No
How frequently do you visit Buffalo's *
First visit
1-2 visits per month
3-5 visits per month
5+ visits per month
How did you hear about us?
Word of mouth
Billboard
Social Media
Print
Radio / TV
Driving by
Digital Advertisement
Other
Customer Service

Worst
1

2

3

4

5

Best
Speed of Service

Worst
1

2

3

4

5

Best
Product Quality

Worst
1

2

3

4

5

Best
Overall Experience *
Subject of Feedback
Message