Vitality Eating Co.
New Client Intake Form
Full Name
First Name
Last Name
Email Address
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Tell me about you! How many family members am I feeding? Any food allergies? Favorite foods? Foods that give you the ick?
I agree to paying between $100-$150 per family member, per week, via Venmo to @hehmi-ely for grocery's within 24 hours of the Venmo request
Yes
No
I agree to paying a non-refundable $250 on the 1st of the month for the Service Fee for Vitality Eating Co. via Venmo to @hehmi-ely
Yes
No
My Venmo handle is...
Submit
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