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Salutation:
First Name:
Last Name:
Title:
Business Address:
City:
State:
Zip Code:
Phone: (xxx-xxx-xxxx)
Fax: (xxx-xxx-xxxx)
Email:
Username:
Password:
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School Name:
School District:
Number of Schools in District:
District Enrollment:
Breakfast Average Daily Participation:
Lunch Average Daily Participation:
Kellogg Sales Representative:
Distributor Name:
Distributor City:
Distributor State:
Self Operated:
Contract Management Company:
Co-Op Membership:
Co-Op Membership Name:
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College/University Name:
Please Specifiy Your Job/Function:
Dining Hall
Cash Operation
Catering
Student Enrollment:
Banquet/Catering on site:
Property Name:
Ownership Classification:
Chain Owned
Independent
Chain Brand Name:
Number of Rooms:
Daily Breakfast Covers:
Chain Franchise Owned:
Chain Franchise Name:
Management Group:
Management Group Name:
Full Service Kitchen:
Yes
No
Banquets/Catering Service On-site:
Facility Name:
Specify Facility Type:
Acute Care
Outpatient Care
Long Term Care
Other
Primary GPO (Group Purchasing Org.):
# of Licensed Beds:
# of Employees:
Distribution Name:
Distribution City:
Distribution State:
Contract Management:
Banquets/Catering On-Site:
Establishment Name:
Parent Company/Franchise Name:
Number of Franchises Owned:
Kellogg Sales Rep Name:
Company Name:
Type of Operator: (check all that apply)
Business Activity:
Number of Routes:
Types of Accounts: (check all that apply)
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