Order Online!
Please fill out our 2021 survey below!
* Required fields
First Name:
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Last Name:
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Email Address:
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Address:
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-- Please Select --
1-3
4-6
Haven't
How many times per month do you dine with us?
*
-- Please Select --
Online
Take-Out
>
Third party delivery
How do you order?
*
Any dietary needs?
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-- Please Select --
Seafood
Pork
Beef
Shellfish
Poultry
Which protein do you prefer?
*
Which vegetable do you NOT prefer?
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Which spice do you NOT prefer?
*
Do you prefer chocolate or non-chocolate desserts?
*
-- Please Select --
Yes
No
Do you enjoy a cocktail at dinner?
*
-- Please Select --
White
Red
Rose
Sparkling
Wine preference?
*
Beer choices?
*
Thank you for your support in 2021!
Eddie Bernal and 34th Street Cafe & Santa Rita Teams!!
* So we can best assist you, please complete the fields with orange backgrounds