Survey : Questions

	Please take our short survey to let us know how we can better serve you. You'll automatically be enrolled in the Azteca Fiesta Club where you'll receive a free appetizer card and a free entree card for your birthday and anniversary! In addition, you'll hear about our current specials and news about Azteca Mexican Restaurants near you.

1.	Which location do you normally visit?
	50 characters left.

2.

How often do you visit Azteca for lunch or dinner?

Once a week or more

2-3 times a month

Once a month

Once every 2-3 months

Once every 4-6 months

A couple times a year

First visit

3.

In which ways do you think Azteca restaurants excel, based on your experiences overall?

Service

Cleanliness

Atmosphere

Food Quality

None of the Above

Other

4.

Will you recommend Azteca to your friends, family and co-workers?

I definitely will

I probably will

I probably will not

I definitely will not

5.

Would you like to receive information about what's happening at Azteca from time to time? (If you check no, please leave your email address blank)

Yes

No

6.

In order to receive your free appetizer, you must provide us with your name and address so we can mail you the promotional card. If you would like to receive birthday and anniversary gifts for you and your family members please fill out the appropriate fields below. Azteca will never sell your personal information. Only one survey per household is eligible for the appetizer promotional card.

By entering my personal information, I consent to receive email communications from the survey author's organization based on the information collected.

First Name:
Last Name:
Email Address:	emailaddress@xyz.com
Address 1:
Address 2:
City:
State/Province (US/Canada):
Postal Code:

	Please fill out the information below.

7.	Your Birthday Month:
	50 characters left.

8.	Spouse's First & Last Name:
	50 characters left.

9.	Spouse's Birthday Month:
	50 characters left.

10.	Wedding Anniversary Month:
	50 characters left.

11.	Child's First & Last Name:
	50 characters left.

12.	Child's Birthday Month:
	50 characters left.

13.	Child's First & Last Name:
	50 characters left.

14.	Child's Birthday Month:
	50 characters left.

15.	Child's First & Last Name:
	50 characters left.

16.	Child's Birthday Month:
	50 characters left.