Location Information 2. Company Name 3. Contact Name 4. Address 5. City 6. State 7. Zip Code 8. Major Cross Streets 9. Phone 10. Fax 11. Email Address 12. Type of Business 13. Days and Hours of Operation Direct Access to Vending Machines 15. # of Full-time Employees / 16. # of Part-time Employees 17. % of Office Employees / 18. % of Shop Employees 19. # of 1st Shift Employees / 20. # of 2nd Shift Employees / 21. # of 3rd Shift Employees 22. Customer Traffic? Yes No 23. If yes, approximate # of person(s) daily 24. Approximate # of Delivery Drivers / 25. Other 26. Equipment Location on Premises (ie., kitchen, hallway, cafeteria, lobby, etc.) 27. Access or Space Limitations? Yes No 28. What kind of limitations? Doors Stairs Ceilings Other 29. If yes, please explain limitations (width, depth, etc.) Current Services 31. Current Vending Company 32. Existing contract? Yes No 33. If yes, commission? Yes No 34. If yes, Gross or Net? Gross Net 35. % Gross/Net 36. Incentives Need help with this questionnaire? Call (714) 670-6711. Submit