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Placement Application
Property Type
*
Please Select
Hotel/Residency
University
Shopping Center
Airport
Transit Station
Grocery Store
Convention Center
Amusement Park
Other
Property Name
*
Which kiosks are you looking to add to your property?
Pharmabox
Techbox
Glamnetic
Fan Stand
Carlo's Bakery Express
Other
Contact Information
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Contact Name
*
First Name
Last Name
Phone Number
*
Format: (000) 000-0000.
E-mail
*
example@example.com
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Placement Information
Suggested Location in the building
*
Estimated Traffic at the Suggested Location (Daily)
*
Number of rooms in the building
*
Current Occupancy Percentage
*
Is there any additional information you would like to provide about the property?
If available please attach pictures and/or a map of the property.
Browse Files
Drag and drop files here
Choose a file
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Installation Information
Preferred schedule for the installation: (Select all that apply)
Mondays
Tuesdays
Wednesdays
Thursdays
Fridays
Mornings
Afternoons
Loading/Unloading zone
High dock
Floor level
Other
Are there any challenges like stairs, or doors that we should be aware of?
Date
-
Month
-
Day
Year
Date
Submit
Should be Empty: