Restaurant Intake Form

Help us understand your facility so we can provide the best service

Legal Business Name

Please provide the legal business name.

DBA (Doing Business As)

Contact Name

Please provide a contact name.

Phone Number

Please provide a valid phone number.

Email Address

Please provide a valid email address.

Street Address

Please provide a street address.

Address Line 2 (Suite, Unit, etc.)

City

Please provide a city.

State

Please provide a state.

ZIP Code

Please provide a ZIP code.

Operating Hours When are you typically open?

Seating Capacity

Service Style

Kitchen Equipment

List major cooking equipment in your kitchen

Hood Type Type of exhaust hood system

Hood Cleaning Vendor

Grease Trap Vendor

Kitchen Floor Material

Slip Incidents (Last 12 Months)

Pest Control Vendor

Additional Notes

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