Tip Payment Form
According to the service ratings, please choose the tip percentage and calculate the tip amount you should pay.
Dinner Date & Time
-
Month
-
Day
Year
Date
Hour Minutes
AM
PM
AM/PM Option
Waiter/Waitress Name
First Name
Last Name
TIP-SERVICE RATINGS
TIP PERCENTAGE
SERVICE RATING
Less than 5%
VERY POOR
5% - 10%
POOR
10% - 20%
AVERAGE
20% - 30%
ABOVE AVERAGE
30% - 40%
VERY GOOD
40% - 50%
EXCELLENT
Greater than 50%
PERFECT!
Bill Amount ($):
Tip Percentage (%):
Number of People:
Total Tip Amount:
Total Bill Amount:
Tip per Person:
Total Bill per Person:
Final Bill Amount with Tip per Person:
prev
next
( X )
USD
Description
Any other comments, complaints or feedback.
Your Name
First Name
Last Name
Contact Number
Please enter a valid phone number.
Email Address
example@example.com
Payment Methods
Debit or Credit Card
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
Please click one of the PayPal options to complete payment and
submit
the form.
Send!
Should be Empty: