Please complete the form below. Mandatory fields marked *

Feedback Type

1. What type of feedback do you want to share? * Select One Restaurant Delivery Other *Required *Required

Restaurant Location

1. State / Province * Select One *Required
2. City * Select One *Required
3. Address * Select One *Required

Visit Information

1. Date of Visit Please enter a valid date in the format: D/MM/YYYY *Required
2. Time of Visit Time of Visit Hour 1 2 3 4 5 6 7 8 9 10 11 12 Time of Visit Minute 00 15 30 45 Time of Visit AM/PM AM PM Please enter a valid visit time(HH : MM : AM/PM) *Required
3. Visit Type * Not Applicable Dine-in Drive Thru Take Away Delivery Pre-Order Pickup Mobile Kiosk *Required *Required
4. Order Type: Not Applicable HJ App- Delivery HJ Website MenuLog Uber Eats Door Dash HJ App- Pick Up / Drive Thru *Required
5. Docket/Order Number:

Contact Details

1. First Name * *Required
2. Last Name * *Required
3. Country * Australia Country *Required
   *Required
4. State / Province / County * Australian Capital Territory New South Wales Northern Territory Queensland South Australia Tasmania Victoria Western Australia State / Province / County *Required
5. Address * *Required
6. City * *Required
7. Zip / Postal Code * Zip / Postal Code *Invalid *Required
8. Phone * Phone *Invalid *Required
9. Email * *Invalid *Required
10. How May We Contact You? * Select One Email Phone Mail No Contact Necessary *Required

Comments

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Attachments

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