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Customer intake form
Let's get some details about your business
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* Indicates required question
Email
*
Your email
Business name and location
*
Your answer
Contact name
*
Your answer
Contact phone number
*
Your answer
What type of service are you looking for
Beverage only
Snack only
Beverage and snack
Clear selection
How soon would you like service set up?
Your answer
Who will be using the vending services
Your business customers
Your employees
Other:
What are your hours of operation?
Your answer
How many employees at your company?
Your answer
What is the estimated daily foot traffic where the vending machine will be located?
Your answer
Do you currently have a vending provider?
Yes
No
Other:
Clear selection
Any other questions or comments?
Your answer
Send me a copy of my responses.
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