Restaurant Sign Up Form

What is the name of your restaurant?*

Restaurant Phone Number*

Please enter a valid phone number.

Which marketing pieces should we send?

2 Window Clings100 Promo Cards with holderWe Deliver real estate sign format

Restaurant Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Who will our point of contact be?*

First NameLast Name

What is this person's email address?*

example@example.com

What pricing structure would you like?*

Standard (you pay 30% commission on delivery sales)Basic (you pay 15% commission on delivery sales)None (transfer commission on delivery sales to customer)

Accelerate Restaurant Orders - Google Order Delivery button on the web

YES, Delivery OnlyYES, Pickup & DeliveryNo, not interested in more orders

How would you like to receive orders?*

Tablet ($1/day, no phone calls, cellular connection)Fax (confirmation phone call for each order)Email (confirmation phone call for each orderPOS Integration ($1/day, requires compatible ordering platform)

How do you want to be paid?*

Weekly direct depositPay-on-pickup

If direct deposit, what is your routing number and bank name?*

If direct deposit, what is your account number?*

Do you have a website for your restaurant?*

Yes, and we want to add "order delivery" to our current websiteYes, and we have online ordering already taken care ofNo. What do you recommend?

Any Special Notes?

Please upload your logo*

Please upload a copy of your menu*

The Agreement

1. PatriotWaiter is a restaurant marketing company that facilitates meal delivery to consumers. PatriotWaiter will receive orders from consumers and fax, call or message them to the restaurant with an estimated pick-up time. Restaurant will provide to PatriotWaiter, in a timely fashion, the same quality food served in the restaurant. PatriotWaiter will arrange and pay for the delivery of the food by a contracted, insured, independent delivery driver.

2. This agreement shall be for a term of one year from the date first written above. This agreement shall automatically renew for additional one year terms unless either party gives the other party written notice that it does not intend to renew at least 60 days prior to the expiration of the agreement.

3. The Restaurant will receive the percentage of the original price of their product at the point of sale as agreed by above. The Restaurant agrees to give PatriotWaiter the percent off indicated above at the point of purchase. The discount shall be off the restaurant’s regular menu price as printed in the restaurant’s menu. Special order items not on the restaurant’s regular menu will be quoted by the restaurant, and PatriotWaiter will receive the same discount on those items, If the discount rate stated above is less then 30%, then PatriotWaiter may increase the price of the items charged to its customers in an amount necessary for PatriotWaiter to receive a 30% gross profit on the meals purchased from the restaurant. It is understood that PatriotWaiter also collects delivery fees on behalf of its affiliated self-employed delivery professionals and processing fees from its customers, and these fees belong solely to the self-employed delivery professionals and/or PatriotWaiter.

4. PatriotWaiter will contact the restaurant with any issues regarding food quality, incorrect preparation, or timeliness issues. PatriotWaiter will be responsible for any adjustments to the customers due to the handling of the food, order-taking errors or timeliness issues controllable by PatriotWaiter.

5. Restaurant will provide PatriotWaiter with a current menu. Restaurant will notify PatriotWaiter of any menu changes as soon as possible.

6. PatriotWaiter will carry insurance as required by state law.

7. Restaurant will indemnify PatriotWaiter from any claims, or expenses due to any product defects or mishandling by restaurant of its product.

8. PatriotWaiter publishes a Menu Guide and other advertising materials, both printed and online, on a periodic basis. Restaurant hereby grants permission for PatriotWaiter, at its sole option, to include restaurant’s menu and logo in said menu guide and any/all other advertising and marketing. Menu guide will reflect prices charged to the customer as indicated in Paragraph Three.

Signature*

Date*

Date