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Order Date (DD/MM/YY)
First Name *
Surname/Last Name
Email Address
Handphone No.
Company (If Applicable)
Restaurant Ordered From Laksa Shack
The Chicken Rice Shop
Cabana Cafe
Food Lodge
Vegetarian Family Home
Sheesh Mahal
Delicatessen Mandy
O'Briens
Malaysian Spicy Corner
Seri Penang
Type of Feedback * Compliment
Complaint
Inquiry
Suggestion
Please describe your feedback *

 
 
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