What is your first name?

What is your surname?

Which is your favourite type of take away?

McDonalds
Oporto
Pizza Hut

What days of the week do you eat take away?

Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday

How much money do you generally spend each time?

$0 - $3 $4 - $6 $7 - $9 $10+

Please add any comments.