Burgerville Feedback Form
Location Information
Location Visited
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(Not Applicable)
122nd & Stark
162nd & Division
25th & Powell
82nd & Glisan
92nd & Powell
Albany
Battle Ground
Beaverton
Camas
Canby
Carman Drive
Cascade Park
Central Park
Centralia
Convention Center
Cornell Square
The Dalles
Fisher's Landing
Gladstone
Gresham
Hawthorne
Hazel Dell
Heights
Heritage Center
Monmouth
Newberg
Nomad
Orchards
Oregon City
Parkrose
Salmon Creek
Scholls & Allen
St. Helens
St. Johns
Sunset Square
Tigard
Twin Cities
Van Plaza
West Linn
Woodland
Date/Time of Visit
Date of Visit
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Visit Date N/A
Time
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AM
PM
Visit Time N/A
Customer Information
Customer Type
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Not Applicable
Drive-thru
Dine-in
Carry out
First Name
Last Name
Address
Address 2
City
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Customers Country
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Best Method of Contact
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Additional Information
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