Customer Service Poll

Customer Information Name * Street Address City State (abbr.) Zip Code Phone Number Email * Where did you hear about us? How many times do come to our theater?

How was your visit? Date of visit What did you see? * Did you have a good time?

Yes No

Rate the experience
(0 - poor 10 -great) 0 10 What is your favorite film? Tell us more about your experience

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Magazine
Newspaper
Word of Mouth
Other