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Please take a moment to tell us about your experience at this location. Responses to questions marked with an asterisk are required.

On what date did you visit BurgerFi?*

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Approximate Time of Visit

11-4

4-6

6-9

9-Close

What is your guest check number? Your guest check number can be found on your receipt. If you cannot locate your receipt, please skip this question and continue.

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Email Address*

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Confirm Email Address*

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Phone Number* Please enter in XXX-XXX-XXXX format.

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Zip Code*

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First Name*

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Last Name*

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Order Type

Payment Type

Comment About Your Visit*

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Will you return?

Yes

How many times have you dined at this location in the last 30 days?

2-4

5 or More

We respect your privacy and will never rent or sell your information. Must be 18 years or older to join / participate. By providing your email address above, you are opting-in to receive email from our company and you may choose to stop receiving emails from us at any time.

First Name*

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Last Name*

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Contact Email Address*

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Phone Number Please enter in XXX-XXX-XXXX format.

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Select a Location*

Type Of Order

Dine-In

Online Order

Phone Order

Take Out

Date of Visit*

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Order Number

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Order Total ($)

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Upload a picture of your receipt

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Please provide any additional details about your experience

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First Name*

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Last Name*

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Email Address*

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Phone Number* Please enter in XXX-XXX-XXXX format.

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Press Source*

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Location*

Your Message*

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City

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State

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Country

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Please upload the photo or video you are giving permission for BurgerFi International, LLC to use.*

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Social Media Accounts

Twitter

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Instagram

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Facebook

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First Name*

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Last Name*

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Email Address*

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Street Address

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Comments*

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I am over the age of 18*

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I agree to the terms and conditions*

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1) I hereby grant BURGERFI International, LLC (“BFI”) the absolute, irrevocable, perpetual, unrestricted and royalty-free right to record, copy, modify, reproduce, sell, duplicate, edit, display, transmit, distribute, disseminate, publish and otherwise use my name, likeness, picture, image, voice, video, quotations and/or social media postings regarding my experiences at BurgerFi restaurants (collectively, “Images”) now or at any time in the future, for any lawful purpose, including advertising, training, educational and commercial, in any manner or form.

2) By this license, BFI is the sole owner of the Images with the irrevocable and perpetual right to use and reproduce them, in whole or in part, in any and all media now known or later devised, including, without limitation, print, film, videotape, DVD, CD-Rom, the Internet and all social media platforms (including Facebook, Twitter and Instagram). I further grant to BFI the right to incorporate and store any of the Images, in whole or in part, into a computer database for further and continued exploitation and to seek copyright registration for the Images, and/or any derivative works created therefrom.

3) I acknowledge and agree that BFI may, in any way it deems advisable edit, modify, add to or delete the Images.

4) I hereby irrevocably release and hold harmless BFI from and against any claim, costs, injury or damages (including, without limitation, any claim of copyright infringement, defamation or invasion of privacy or for any damages arising from any activities I take hereunder) I may have or may hereafter have in connection with the BFI’s use of the Images, or the broadcast, distribution, marketing and promotion thereof.

5) I represent and warrant that: (a) I am over the age of 18 or that my parents or guardians are signing this agreement with me if I am not over the age of 18; (b) no permission is required from any union or guild for my appearance; (c) I (alone or with my parents or guardians) have the full right and authority to grant the rights granted herein; and (d) I shall not be entitled to any compensation or remuneration of any kind.

This agreement will be governed by the laws of the State of Florida. As used in this agreement, "BFI" means: BURGERFI International, LLC, its parents, affiliates, subsidiaries, franchises, associates, successors, assigns and licensees, and their respective owners, directors, officers, employees, agents and representatives.

First Name*

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Last Name*

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Email Address*

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Phone Number* Please enter in XXX-XXX-XXXX format.

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Select a Location*

Your Message*

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City

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State

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Country

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First Name*

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Last Name*

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Email Address*

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Phone Number* Please enter in XXX-XXX-XXXX format.

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Select a Location

Donation or Fundraiser*

Donation

Fundraiser

Name of Organization*

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Event date you would like to request?*

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Brief Description About the Organization*

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