Visit Survey - Manuel's Mexican Restaurants

Our family sincerely wants to thank you for visiting our restaurant. In an effort to maintain our high standards, please take "un momento" to fill out this survey, We appreciate any suggestions and comments you may have.
Gracias,
The Salazar Family
About You
Name*
First Last
Email*
Phone
City State ZIP Code
Age Group
About Your Visit
Location Visited*
Was this your first visit to Manuel's?*
- Yes
- No
Date of Visit*
Date Format: MM slash DD slash YYYY
Time of Visit*
Server Name
Check Number

About You