Samosky's Homestyle Pizzeria, Inc.

Want a chance to win a free large 2-topping pizza?

All we ask is that you fill out a few questions that will only help us to serve you better. Each month we will select a lucky winner for a FREE large 2-topping pizza! Simply fill out this form completely, click on the “Enter Me” button and you will be automatically entered. Free pizza prize is not valid with any other pizza deals or coupons. We will contact you by phone or e-mail if you win. Thanks for taking the time to enter, and GOOD LUCK!

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How often do you order pizza?

Would you like to receive coupons or special offers via e-mail?

Please rate the following from 1 to 5 (5 being most important)

*Value for the money*	5	4	3	2	1
*Freshness*	5	4	3	2	1
*Restaurant Appearance*	5	4	3	2	1
*Customer Service*	5	4	3	2	1
*Quality*	5	4	3	2	1

What other pizza restaurants do you like and why?

Do you have a favorite menu item at Samosky's?

Is there something you would like to see on Samosky's menu?

Any Additional Comments?



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