PizzaNet.Net

This restaurant is being recommended by:
Your Name:
Your Email Address:
Note: We will email a form to you for completion and signature by an authorized representative of the business.

Full Legal Business Name:
Corporation Partnership Proprietorship
Doing Business As (Name of Establishment, if different):
Headquarters Street Address:
Mailing Address:
City:
State/Province:
Zip/Postal Code:
Phone #:
Fax #:

With our system you do not need to maintain your own email address, but if you already have one, please indicate it below.
Your Business Email Address (if any):
Your orders will be transmitted to your fax machine unless you maintain a direct Internet connection, in which case you would have the option of receiving orders directly to your local email account. Is the above email address accessed by you continuously through a dedicated Internet connection. No Yes

We will prepare a website for you, including an interactive version of your menu and any other information you wish to provide. If you already have an advertisement on the Internet please specify the Internet Address below.
Current Internet Address (if any):

We will be creating an Internet Website Home Page for your business. We will supply you with the Internet address (or URL) which you can employ in your advertising. It will appear, for example, something like "https://www.PizzaNet.net/yourname/".

In business since: Number of Branch Locations:

Type of business:

Please provide a rough estimate of the percentage of business which is
Delivery: %
Take Out: %
Eat-In:%

Number of delivery persons employed:

Credit Cards Accepted: Visa Mastercard American Express Discover Diners Club
Other Credit Cards:

Are your Delivery Persons equipped to accept Credit Card Info at the door?
No Yes Some

Please provide the following information for each location:
Location Name:
Street Address:
City: State:
Phone: FAX #:

Delivery Area Zip Codes:

Delivery Area Telephone Exchanges:

Delivery area boundary description:

Dates or Holidays Closed:

Agreement

This agreement is between The Internet Pizzeria, hereinafter known as "PizzaNet.Net" and the business establishment identified above, hereinafter referred to as "Business". PizzaNet.Net agrees to advertise and promote Business on the Internet, and to maintain systems designed to accept sales orders from computer users. Business agrees to maintain a fax machine and/or an email account to facilitate receipt of orders, to process food orders submitted by PizzaNet.Net, and to pay fees on such orders amounting to $1 on each order under $25, $2 on each order of $25 to $100, and $5 on orders of $100 or more.

Signer Name:
Signer Title:
Signer Social Security Number:

By signing below I represent that I have read this Agreement, that I have authority to act on behalf of the business named above, and that the business agrees to be bound by this Agreement.

Signed by: __________________________________________________

Date: ________________

Mail this completed form along with a copy of the restaurant's delivery menu and other pertinent materials to:

The Internet Pizzeria
543 State Route 11B
Potsdam, NY 13676

You can also fax this form to 315-268-8201.

When finished click on the Submit button. A partially completed form will be emailed to you for signature by an authorized representative of the business.

Only press Reset if you want to start completely over.