Comment Cards

Essencha is ready to listen to you! Tell us what we are doing right and what can be improved. Please fill out this short questionaire and be eligible for a drawing of a $25 gift certificate valid at Essencha Tea House.

Title: Mr. Mrs. Ms. Miss First Name:   Last Name:   Street Address: City: State/Province/Region: -No State/Province- Alabama Alberta (Can) Alaska Arizona Arkansas British Columbia (Can) California Colorado Connecticut Delaware Dist. of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Manitoba (Can) Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Brunswick (Can) Newfndlnd and Labrador (Can) New Hampshire New Jersey New Mexico New York North Carolina North Dakota Nova Scotia (Can) Northwest Territ. (Can) Nunavut (Can) Ohio Oklahoma Ontario (Can) Oregon Québec (Can) Pennsylvania Prince Edward Il. (Can) Rhode Island Saskatchewan (Can) South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Yukon (Can) Other: Zip/Postal Code:   BirthDay: January February March April May June July August September October November December / 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Language: English Chinese French German Italian Japanese Spanish Other Email:      Number of Visits: 1 2 3 4 5 More than 5  Purpose of your recent visit: Breakfast Lunch Afternoon Tea Other How did you hear about us? <-- select one --> Cincinnati Enquirer Cincinnati Magazine City Beat Driving by Referral from Friends Search Engine - Google Search Engine - Yahoo Search Engine - MSN Search Engine - Other TV Ad Word of Mouth Other How was your experience?  Tea Excellent Very Good Good Poor Very Poor  Food Excellent Very Good Good Poor Very Poor  Service Excellent Very Good Good Poor Very Poor  Atmosphere Excellent Very Good Good Poor Very Poor  Cleanliness Excellent Very Good Good Poor Very Poor  Would you visit Essencha again? Yes No  Would you refer a friend? Yes No How can we improve?  May we contact you? yes no Name of your server (if you can't remember name, please describe):  Date of your visit: