Internet Restaurant Review Form
To Horizon Telemedia

Reviews are accepted from the public, but we reserve the right to confirm, edit, refuse, or remove any that we publish. Please fill in all information requested that is not marked 'optional'. Thank you for your assistance! /Horizon Telemedia.

REVIEWER INFORMATION (About You)

One Time Review I'd Like to Review Often I'd Like to Work as a Reviewer/Agent

Your E-mail Address: (Required)

Your Name: (Required)
Your Home Phone (Optional):

Meals I have eaten at this restaurant: (Check all that apply):
Breakfast Lunch Dinner Coffee/Dessert None

At this establishment I am: Owner/Mgr/Worker Patron/Customer Neither

Your Sex: Male Female
Your Age Group: Under 21 21-30 30-40 40-50 50+


RESTAURANT BASIC INFORMATION

Name of Establishment:
Address:
Tel: (Required)
Between which Streets or Avenues, or at what Corner:
Name of Locality (Chinatown, Upper West, Chelsea, Queens, New Jersey, etc):

Manager or Owner (Name to Contact):
Hours of Operation: From: To:
What is the dress code Required Recommended Not Important
Check the rightmost button that applies:
No Alcohol BYO Beer/Wine Only Full Service Has Bar/Lounge Extensive Wine Selection

Smoking Policy: None Cigarrettes OK Pipes OK Cigars OK Separate Area All Areas

Reservations: Accepted Not Accepted For Lager Parties

Credit Cards Accepted: All Major Visa Master Amex/Optima D.C. C.B. Discover

Minimum per

Delivery Zone (If applicable):


YOUR REVIEW

Ambiance:

Your Review Text: . . . . (Please hit 'Enter' at end of lines)

What is the average bill per person, without Alcoholic beverage:
Please try to fill in the following from the menu:
Lowest cost dinner or entree Highest cost dinner or entree
Lowest cost dessert Highest cost dessert
Lowest cost salad or appetizer Cost of coffee (regular)

Any other comment you have for us at Horizon Telemedia: