Name *

(please provide the name listed on your receipt, if possible)

First Name

Last Name

Date of your visit/event *

MM

DD

YYYY

Were you greeted?

Yes

No

Don't remember

Was our staff friendly?

Yes

No

Don't remember

Were you given satisfactory explanations on how to paint or glass fuse?

Yes

No

Did someone check in to see how you were doing?

Yes

No

If you had a party, did our staff help your event run smoothly to your satisfaction?

Yes

No

Not applicable

May we contact you?

Yes

No

Phone

(###)

###

####