GiftAMeal Sign Up Form

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Restaurant Name: *

Number of Units *

Would you like to upload a file with a list of your locations or manually enter the addresses? *

Upload a File

Manually Enter

Restaurant Addresses: * 🛈

Addresses: *

Pricing: *

Annual

Monthly

Term: 12 months

Features:

○ Monthly donation of 30 meals per location +1 per photo share (paid by GiftAMeal)

○ Dashboard reporting on per-location and system-wide basis

○ Design assistance for promotional materials and digital graphics

○ Branded to restaurant's colors

○ Royalty-free license to use and republish user-created content (photos/captions)

Start Date: * +

First Name *

Last Name *

Title *

Individual's Phone Number *

Email Address *

Payment Options *

ACH Collection (Bank Account)

Credit Card

Credit Card

Cardholder Name (as it appears on the credit card) *

Credit Card Type *

Credit Card Number *

Expiration Date (mm/yy) *

CVV Code *

Billing Address:

Street Address *

Address Line 2

City *

State *

Zip Code *

Authorize Credit Card Payments *

Restaurant elects to make payments via pre-authorized credit card charges.

ACH Collection

Business Name (as it appears on the account) *

Account Type *

Checking

Saving

Personal or Business *

Personal

Business

Bank Name *

Bank Transit Routing Number - ACH (9 digits) *

Bank Account Number *

Authorize ACH Collection *

Restaurant elects to make payments via pre-authorized automatic clearinghouse (“ACH”) debits.

Terms *

Restaurant agrees to GiftAMeal’s Terms and Services Agreement, which are attached hereto and incorporated herein by this reference.

GiftAMeal Terms & Services Agreement

Signature *

clear

Email: info@giftameal.com | Phone: 314.656.6244