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*Indicates Required Field

First Name*

Last Name*

Title*

Email Address*

Company*

Phone Number (area code required)*

Address Line 1*

Address Line 2

City*

State/Province*

Country*

Zip/Postal Code*

Will your offering be given away/complimentary or charged for/revenue generator?* Given Away/Complimentary
Charged For/Revenue Generating

Do you consider the primary consumers to be employees and guests or patrons?* Employees & Guests
Patrons

Will consumers serve themselves?* Yes
No

It sounds like you're interested in a Foodservice offering.* Yes
No
Not sure? Click here to find out more.

It sounds like you're interested in Office Coffee Services.* Yes
No
Not sure? Click here to find out more.

How many people are in your office or do you plan on accommodating?*

What type of industry is your business?*

Do you currently use an office coffee service?* (If yes, please tell us who your current office coffee provider is, as they may already be a Preferred Office Coffee Provider.) Yes
No

Name of provider

City of provider

What brand of coffee do you currently use?

Approximately how much do you spend on office coffee per month? $50–$99
$100–$249
Over $250

How did you hear about Starbucks Office Coffee Service? Referral
Web or print ad
Google
Other

Are you the coffee decision maker for your operation?* Yes
No

Business Segment*

Customer Type* Single Unit
Multi Unit

Single units are typically thought of as single-building businesses or independent accounts. Multi units are what some might refer to as national accounts or “chains”.

Account Name

Operation Name*

Is this a new business?* Yes
No

What is your open date?

Do you currently serve coffee? Yes
No

What is your current coffee brand?

What is your current distributor?

Do you own your current brewing equipment? Yes
No

Do you currently serve tea? Yes
No

What type of tea do you serve? Hot
Cold
Both

What is your current tea brand?

What is your current distributor?

How many employees do you have?*

How many days a week will coffee be offered?* Less than 5 days a week
5 days a week
6 days a week
7 days a week

Number of potential coffee stations/locations*

Do you currently serve or are you planning to serve more than 1,600 12-oz. cups per week?* Yes
No

1,600 12-oz. cups = 50 lbs./week

Which pack sizes do you use or do you plan on using?

How many cases of product do you use or do you plan on using weekly?

Do you currently serve or do you plan on serving ground or liquid coffee? Ground
Liquid
Both

What products are you interested in serving? (Check all that apply): Brewed Coffee
Espresso
Teavana^TM/MC Tea
Blended Coffee
Fontana® Syrups
VIA® Ready Brew
VIA® Refreshers™

Have you inquired with us before? Yes
No

Additional Comments

Verification*

Orders placed between 4/21/16 through 4/26/16 will be delayed up to two business days due to a system upgrade.

Become A Customer