Free Coffee Shop Information Form

Please fill out this form so we can provide you with the best coffee experience possible.
Name
Birthdate
Phone Number
Email Address
Favorite Coffee Type
Brewed Coffee
Espresso
Cappuccino
Cold Brew
Latte
Milk Preferences
Whole Milk
Almond Milk
Oat Milk
Skim Milk
Sweetener Preferences
Sugar
Honey
Sugar-Free Syrup
Special Requests or Allergies
Please let us know if you have any special requests or allergies:
When Do You Typically Visit Our Shop?
Morning
Afternoon
Evening
Are you Part of Our Loyalty Program?
How Did You Hear About Us?
Social Media
Online Search
Friend/Family
Would You Like to Receive Promotions or Updates?
Signature
By signing, you consent to the information provided being used to enhance your experience at our coffee shop.
Name:
Date:
Thank you for submission!
We appreciate you taking the time to submit.
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