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* 1. How would you rate the service?

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* 2. How would you rate the ambience?

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* 3. How would you rate the menu choice?

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* 4. How would you rate the food?

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* 5. What date did you visit The Pen and Pencil?

Date

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* 6. What day of the week did you use your voucher?

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* 7. Did you use your voucher for

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* 8. What total value voucher(s) did you use to pay?

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* 10. If you left a tip for your server, did you calculate the amount based on

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* 11. If you left a tip, how much tip did you leave?

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* 12. If you did not leave a tip, why did you decide not to?

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* 15. Would you return without a gift voucher?

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* 16. Have you returned to Confidentials to purchase more vouchers for The Pen& Pencil since your initial visit?

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* 17. When did you purchase your voucher?

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* 18. "I have more to say!" - Sure, use this box...

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* 19. Fill in your contact details

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