Business Owners and Operators Inquiry Form

First and Last Name:
Email Address:
Daytime Phone #:
Address:
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Establishment Type (ie. Restaurant, Bar, etc):
Do you currently have an Amusement Vendor? Yes No
If you currently have an Amusement Vendor, what is the name of your vendor?
If you currently have an Amusement Vendor, how often is your location collected?
If you currently have an Amusement Vendor, what is your approximate profit share?
What are your hours of operation?