RJ's Eatery
1913 E. Grand Ave
Lindenhurst, IL 60046
by Phone:
847-356-2300
Personal Information
*title:
*first name:
*last name:
*email:
*birthday (MM/DD/YYYY):
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*home phone number:
work phone number:
address 1:
city
state:
zip code:
country:
Restaurant Information
Employee Name (if known)
Brief Description of Employee
DATE AND TIME OF VISIT:
month:
day:
year:
time of visit:
hour:
minute:
AM or PM :
Comments
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PLEASE NOTE: RJ's asks for your birthdate in order to comply
with the Children's Online Privacy Protection Act (COPPA), which prohibits the
collecting of personal information of anyone under the age of 13.