The Signature Room® : The Restaurant Chicago Looks Up To®

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Thank you for visiting The Signature Room's® website. We want you to have a truly enjoyable and memorable experience each time you visit our restaurant or banquet facilities. Please take a moment to share your comments, suggestions or questions about our food, service and ambiance.

First Name:

Last Name:

Phone Number:

Fax Number:

Mailing Address:

City:

State:

Zip:

Email Address:

1.) When was your visit with us? Date:

2.) Which location did you visit?

3.) How often do you dine with us?

The Signature Room at the 95th®
(downtown)

	First time
	Once in a while
	Regularly

4.) How was our greeting staff?

excellent

10 9 8 7 6 5 4 3 2 1

poor

5.) Tell us about your food?

excellent

10 9 8 7 6 5 4 3 2 1

poor

6.) How was your server?

excellent

10 9 8 7 6 5 4 3 2 1

poor

7.) Tell us about the ambiance/atmosphere?

excellent

10 9 8 7 6 5 4 3 2 1

poor

8.) How do you feel overall about your experience?

excellent

10 9 8 7 6 5 4 3 2 1

poor

Was our establishment clean?

yes no

Restrooms clean?

yes no

Would you like to be contacted?

yes no

Additional Comments:

Please check this box if you would like to receive promotional mailings and e-mails from The Signature Room at the 95th® regarding new menus and upcoming exciting events. The Signature Room at the 95th® will never disclose your personal information to third parties.

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