Please Fill out the following information
Business Information
Business Name
*
Billing Address
*
Shipping Address
*
Business Type
Cafe
Restaurant / Bakery
Grocery
FUNDRAISER
Caterer
Hospitality
Buyer's Club
Health Food
Church/Faith Group
Contact
Weekly Order Email
Contact Name
*
Email Address
*
Phone Number
*
Billing / Invoice
Contact Name
*
Email Address
*
Phone Number
*
Other Contacts
Contact Name
Email Address
Phone Number
Are you Interested In:
Packaged/ Retail Coffee
Bulk Coffee
Both
Would you like to brew Equator coffee (drip, espresso, etc.)
No
Yes
If yes, what type of equipment will you be using?
Make
Model
Payment Information
*For the first 6 months of business with Equator, payments must be made prior to order delivery/shipment. Terms can be negotiated after 6 months of steady payment. We accept the following forms of payment:
*
Cheque
E-Transfer
Direct Deposit
CREDIT CARD
Submit
Should be Empty:
Now create your own Jotform - It's free!
Create your own Jotform