Venue Information Form
Please complete the following information so we may review your location.
Your Full Name
*
First Name
Last Name
Cell Phone Number
*
E-mail Address
*
example@example.com
Relation to the location (Owner, General Manager, etc)
*
How did you hear about us?
*
Are you familiar with the adult nature of some of our standard products?
*
Yes
No
Business Location Name
*
Business Location Website
*
Business Location Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
How many locations do you have?
*
Type of Business (Bar, Restaurant, Brewery, etc)
*
Daily Typical Foot Traffic
*
Under 50 Customers
50-200 Customers
200-500 Customers
500+ Customers
Primary Customer Demographic
*
Families
Young Adults / Teens
21+ Only
Mixed
Preferred placement within your venue for the Mystery Box
*
Is there a standard power outlet within 6ft of the preferred location?
*
Yes
No
Please share anything else we should know about your business location for consideration:
Submit
Should be Empty: