ABOUT YOUR RESTAURANT/BAR/CAFÉ
Name of establishment
*
Type of establishment (please select one)
*
Restaurant
Bar
Coffee Shop
Brewpub
Other
Establishment address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Establishment phone number
*
Are you currently offering delivery/takeout/drive-through?
*
Yes
No
Is your establishment a franchise?
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Yes
No
Is your establishment part of a Restaurant Group?
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No
Other
How many employees did you have before the COVID-19 pandemic?
*
How many locations do you have?
*
Please tell us a little bit about your business.
*
Please briefly tell us how your restaurant(s) have been impacted by the COVID-19 pandemic.
*
Does your establishment have a website?
*
No
Other
ABOUT YOU
First name
*
Last name
*
Email
*
Phone Number
*
What is your title/role?
*
Owner
Manager
Other
By submitting this form, I confirm that I am a resident of the United States and my restaurant is experiencing economic hardship as a result of the COVID-19 pandemic. I fully agree to the Terms and Conditions of this initiative.
*
I agree
By submitting this form I confirm that I allow the name of my establishment to be mentioned in media or press interviews.
*
I agree
By submitting this form, I understand that my participation is contingent upon my establishment generating a receipt that clearly states establishment name, address and date of transaction. Generic register receipts will not be accepted.
*
I agree
Submit
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