Kitchen Application - To Go Kitchen, LLC

Application Date:

Business Name & Legal Structure (e.g. LLC, C-Corp, etc.)

Business Street Address

Week startup, and

Business City, State, and ZIP

EIN (Optional)

OR State Business License Number

Business Stage (e.g. startup, growth, decline, etc.)

Number of Employees (including you)

Insurance Policy Company Name, Number, and Expiration Date

Department of Agriculture OR Department of Health Inspection Date (if known)

Food Manager's Certification Number or Food Handler's License Number and Expiration Date

Description of Your Products

Where Are Your Products Being Produced Now? (e.g. in your home, another kitchen name, etc.)

Equipment Needs

A list of all equipment needed to produce your product(s).

Estimated Time in the Kitchen Required

Please state the number of hours needed and if that number is per week or per month.

Days of the Week and Times Requested

Please enter your 1st and 2nd choice of day(s) and time(s).

Business Goals and General Plans to Get There

Please give us a short synopsis of your business plan for the next 2-3 years.

Current Sales Channel(s)

How Did You Hear About Us?

Name

First

Last

Home Address

Phone Number

Please include area code.

Billing Address (if different from Business Address)

Driver's License Number & State (or other government issued ID)

Emergency Contact Name

Emergency Contact Phone Number

Secondary Contact Name (if applicable)

Secondary Contact Phone Number

Secondary Contact Email