Dear customer,
We here at Nostralis are going to make a few new and exciting changes to our business, not in the way we cook our meals but in the way we run our business such as rewarding customers with loyalty cards, informing them of new menus, upcoming events etc. For this we are going to require email addresses and/or postal addresses so we can build a data base which we can use for this purpose.

If it is possible could you please provide us with and address/email address so that we can use to contact you. Thank you and we appreciate your time.

Name:                 Email:                 Date of Birth:    (YY-MM-DD)