To our visitors online, we thank you for exploring our site. If you take a moment to complete this form, your name will be entered into a special drawing to win a FREE Prime Cut and a large Root Beer OR a Breakfast Special and Coffee. The winners will be contacted by email.

1. What is your name?

2. Your email address?

3. Have you eaten at the Triple XXX Family Restaurant?
Yes No

4. You live in:
City: State: Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Puerto Rico Other

5. Your birthday (month and day)? (We'd like you to be in our Birthday Club).

6. Comments and/or suggestions:
I think...

Thank you for taking the time to submit your entry, and Good Luck! We look forward to seeing you at The Triple XXX Family Restaurant.