FOOD AND BEVERAGE INTEREST SUBMISSION

CUSTOMER INFORMATION

Customer Name

Customer Phone #

Customer Email Address

Customer Account/Site #

BEVERAGE

Do you currently offer a COFFEE / HOT beverage program?

If yes, which coffee brand is most prominent in your store(s)?

Interested in NCD's coffee brands below?

Other

Approximately, how many pounds of coffee per week do you sell?

Is this location clean and sanitary for Beverage programs?

Is there a water line with fitting?

	Electric 110v	Electric 110v 20 amp (VKI only)	Electric 220 v L1430 plug style required
Outlets for Beverage Information	Enter how many	Enter how many	Enter how many

Is there a drain in the counter?

Does the customer OWN any of their equipment?

Dimensions of Beverage Counter

Be detailed with inches/feet/height/width/length

BEVERAGE AREA - UPLOAD A PICTURE

FOOD SERVICE CUSTOMERS NEED TO HAVE SERV SAFE, 3 COMPARTMENT SINK, AND A FOOD LICENSE

Does the customer have their serv safe and food license?

Does this store have a 3 compartment sink and proper cleaners?

Does this store have a food prep area?

Is there a hand wash sink near the food prep area?

Does this store have enough fridge and freezer space?

Does this store have enough employees to handle prepared food?

Does this store have an oven?

OVEN - UPLOAD PICTURE(s)

Does this store have a warmer?

WARMER - UPLOAD PICTURE(s)

Does this customer need to purchase new equipment?

WHICH EQUIPMENT ARE YOU RECOMMENDING?

FOOD AREA - UPLOAD PICTURE(s)

OTHER PROGRAM INTEREST

BEVERAGE INTEREST

SELECT ALL THAT APPLY

FOOD SERVICE INTEREST

SELECT ALL THAT APPLY

EQUIPMENT INTEREST

SELECT ALL THAT APPLY

SALES CONSULTANT INFO

NCD DIVISION / DISTRIBUTION CENTER

Chicopee

YOUR SALES REP NAME IS...

Farmingdale

YOUR SALES REP NAME IS...

Rockville

YOUR SALES REP NAME IS...

Philly

YOUR SALES REP NAME IS...

Tampa

YOUR SALES REP NAME IS...

COMMENTS/NOTES/OTHER

Contact Information