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Name: Phone Number: Fax Number: E-Mail Address: Town: Favourite Food Styles: American Caribbean Chinese English French Indian Indonesian Italian Italian and Pizzeria kurdish Lebanese Mexican Pakistani Palestinian Spanish Pizzeria Thai Turkisk Other How Many Times do you eat out a Month: Once a Month Twice a Month Three times a Month Four Times a Month Five tines a Month More than Five Times More Than Ten times Restaurant to be reviewed: Town: Phone Number (If poss, if not already listed) Address of Restaurant (if poss, if not already listed): Review: