Feedback Form

Bootleggers Signup

()

Feedback Form

We would appreciate feedback about your last visit to Bootleg.

FREE GIFT!.

Fill out our feedback form below, and we will give you a great keyring next time you visit Bootleg Brewery.

Just come up to the bar and tell the staff your name and that you have completed our feedback form.

The staff member will check your name of the list and give you a great Bootleg keyring

Please fill out relevant fields in our feedback form below.
We do not distribute any information to any persons or entities whatsoever. Please see our privacy policy


Your Name	:
Date of Visit	:
Phone or Email	:
Reply Contact	:	No YES
Quality of Service	:	Excellent Above Average Average Below Average Poor
Quality of Food	:	Excellent Above Average Average Below Average Poor
Please State Meal Chosen	:
Comments About Meal	:
Quality Of Beer	:	Excellent Above Average Average Below Average Poor
State Beer Selections	:	Light Lager Wils Pils Settlers Pale Ale Tom's Amber Ale Sou' West Wheat Raging Bull
Age Range	:
Number of Guests	:
First Time Visitor?	:	NO YES
How Did You Hear About Us	:
Additional Comments	:

Please check field responses, then click button and wait to be redirected.



2008 Copyright Bootleg Brewery Margaret River. All Rights Reserved	Feedback Form \| Privacy Statement