1105 Kitchen Request Application
Full name *
Your answer
Company
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Address (Line 1)
Your answer
Address (Line 2)
Your answer
City
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State
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Zip
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Email address *
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Phone number *
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Website
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Business partners
Your answer
Number of current employees other than yourself
Your answer
Business status
Business structure
Do you have a business plan?
If you business is 1 year or older, please indicate your approximate annual sales ($).
Your answer
Briefly describe your business
Your answer
Briefly describe the products, including the main ingredients and the equipment you wish to use in the kitchen.
Your answer
Where do you plan to sell your product?
Estimated frequency of kitchen use
Preferred days
Preferred time of day? (Note--the kitchen is NOT available between 7 a.m. and 5 p.m. Monday through Saturday)
Time
:
If yes, which months?
Your answer
How did you hear about the 1105 Kitchen?
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This form was created inside of The Crisis Center of Johnson County.