GiftAMeal Sign Up Form

EXCLUSIVE OFFER FOR PERFORMANCE FOODSERVICE CUSTOMERS ONLY

Subscription Type *

$59/month (Paid Annually)

$69/month (Paid Monthly)

• Covers all donation costs plus 50 bonus meals per month

• Free promotional materials + design assistance

• Monthly reports and social graphics celebrating your impact

• No effort or logistics for you or your staff

• Sign up, receive promotional materials, and launch within a week!

Note: for food banks with a cost/meal of 50 cents or more, the bonus meal donation will be 30 meals per month.

How many locations are you signing up? (Maximum 5 for Online Sign-Up) *

Start Date * +

Restaurant Name *

Street Address *

Address Line 2

City *

State *

Zip Code *

Restaurant Name (2) *

Street Address *

Address Line 2

City *

State *

Zip Code *

Restaurant Name (3) *

Street Address *

Address Line 2

City *

State *

Zip Code *

Restaurant Name (4) *

Street Address *

Address Line 2

City *

State *

Zip Code *

Restaurant Name (5) *

Street Address *

Address Line 2

City *

State *

Zip Code *

First Name *

Last Name *

Title *

Individual's Phone Number *

Email Address *

Payment Options *

Bank Account (ACH Collection)

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.

GiftAMeal’s Terms and Services Agreement

Terms *

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

Signature *

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Email: info@giftameal.com | Phone: 314.656.6244