FREQUENT DINER APPLICATION FORM

Please accept this invitation to become a part of our frequent diner program. The card you will be
receiving costs you absolutely nothing, but you will earn valuable rewwards every time you use it.
Your card and details of the program will be sent to you within a few weeks. Thank you!
*denotes required field
 

NAME*

 
SPOUSE NAME
STREET ADDRESS*
CITY*
STATE*
ZIP CODE*
PHONE NO.*
FAX NO.
BIRTHDAY *
SPOUSE BIRTHDAY
ANNIVERSARY

COMMENTS: Please take a moment to give us your comments regarding our restaurant,
including suggestions on food items or specials you would like added or deleted. Plus any
suggestions we may use to make your dining experience more enjoyable. Thank you!