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| Name: |
Title: |
| Company: |
| Address: |
| City: |
Province/State: |
| Postal Code: |
Email: |
| Phone: |
Fax: |
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| I'll pay by: |
Cheque (payable to Ishcom Publications)
Visa
Mastercard
Amex |
| Card Number: |
| Expire: |
| Signature: |
GST Reg. # R102 533 890 |
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| Primary Business (check one box only) |
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Restaurant |
Motel/Inn |
Fast Food |
Resort |
Industrial Cafeteria |
School |
Food/Bev Processor |
Distributor |
Multi-Unit Restaurant |
Broker |
Tavern |
Distiller |
Dept. Store |
Brewer |
Nursing Home |
Hospital |
Vintner/Wine Agent |
Equip Manufacturer |
Banquet Hall/Caterer |
Government |
Vintner/Wine Agent |
Equip Manufacturer |
Banquet Hall/Caterer |
Government |
Contract Foodservice |
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| Check boxes that describe your business |
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Chain Owned |
Franchise |
Independent |
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| Is your business licensed to sell alcohol? |
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Licensed |
Unlicensed |
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| Job function (check one box only) |
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Owner/Operator |
Chef/Kitchen Mgr |
Marketing/Sales |
Purchasing |
Dining Room Mgr |
Food & Bev Mgr |
President |
Bar Mgr |
Manager/Director |
Teacher |
Other _______________ |
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