Welcome to
Jimmy Java!


Feedback

WIN a GIFT CERTIFICATE from Jimmy Java!

Tell us how your visit was! Fill out our feedback form below.

You may remain anonymous, but if you wish to leave your name and a phone number or e-mail address you'll be entered into a draw to WIN a $10 gift certificate!

If you prefer, you may send an e-mail to one of the following addresses:
leon[at]jimmyjava.com
webmaster[at]jimmyjava.com

Feedback Form

Only Fields marked with an asterik (*) are required:
If you have any comments about the points below or anything else, please include it in the comments field at the end of the form.

For the questions on a scale of 1 to 5:
1=strongly disagree, 2=disagree, 3=neutral,
4=agree, 5=strongly agree, or n/a=does not apply

* Date and Time you visited our shop:
* Did you make a purchase? Yes
No
* Your server was courteous and friendly. 1
2
3
4
5
* Your server was helpful and knowledgable about the menu. 1
2
3
4
5
n/a
* Your server was prompt and efficient. 1
2
3
4
5
n/a
* The store was clean and attractive. 1
2
3
4
5
* The drink or product you ordered was prepared to your liking. 1
2
3
4
5
n/a
* We had an adequate selection in stock. 1
2
3
4
5
n/a
* You felt your business today was appreciated by us. 1
2
3
4
5
n/a
* You had a comfortable and relaxing visit to our store today. 1
2
3
4
5
Comments:
Name:
Phone Number:
Email Address:
Recommend your favorite drink! We'll post your recommendation on our "We'd Like To Recommend" page (we will only use your first name and initial to identify you). Please give us the drink name and a short reason why you love it!
Check the box to be entered into the draw for the prize pack (you must have provided your name and a phone number or e-mail above) Yes, I want to enter the draw

form creator

Please note, the email addresses are written to avoid detection by spambots. Please copy them into your email program and adjust them as necessary. We apologize for the inconvenience.


(Updated on May 6, 2008)