Customer Service Form

To ensure a timely response, please fill in as much information as possible in the form below.

Fields noted by an '*' are mandatory and must be filled for the form to be processed.

Information about you:

Mr.    Mrs.    Ms.

            *First Name:

            *Last Name:

       *Email Address:

                *Address:

                  Address:

                      *City:

               *Province:

                     Phone:

If your comment or question involves a particular store,

please enter as much information as possible about that location below.

        Store Address: Burger Inn 4th Street Sw Burger Inn Macleod Trail SW Burger Inn Bow Trail SW

  Date of Store Visit: January February March April May June July August September October November December   1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31   2005 2004 2003

         Approx. Time: 1 2 3 4 5 6 7 8 9 10 11 12 : 00 15 30 45   AM PM

This is where you write your message (500 Character Limit):

                       Please hit Submit when you are done filling out this form.
                   Press Reset, if you would like to clear this form and start again.
           Note: If for some reason this form does not work in your web browser
                      you can e-mail customer service at: info@burgerinn.com