Premier Foodservice Program Enrollment Form

Please complete this form and read and agree to the Terms and Conditions in order to access the Premier Foodservice Program (“The Program”). In order to enroll as a Roster Participant in the Program, you must be a current U.S. Communities Participant.  If you are not a U.S. Communities Participant, please register with U.S. Communities at http://www.uscommunities.org/register/start-registration.aspx

(*) Required fields.

Confirmation

Please confirm that you are a U.S. Communities Participant by checking the box to the left before continuing.


Contact Info






E-mail

Phone  (000.000.000)

Fax  (000.000.000)


Account Information


Federal Tax/Employee Identification No.(TIN/EIN)

Primary Street Address

City

State

Zip

Phone  (000.000.000)

Fax  (000.000.000) 


Agency Type 
Agency/Facility Type


Specify (if you selected "Other") 



Food Purchasing








Average Food Drop Size: $


Agency Relationships
Does your agency have a relationship with any other public agency? If yes, please explain the relationship. (ex. Yes, we are owned by the state.) 


Ship to/Child Sites

If you will be accessing the Program on behalf of ship to/child sites, please download and complete this spreadsheet template ("Shedule 1") and email it to Premier in order to ensure that they are linked to the program.


Terms and Conditions

  I agree to the Terms and Conditions of participation on behalf of the Roster Participant and all facilities listed on the ship to exhibit.

The individual who submits this form on behalf of the Roster Participant represents and warrants that he/she is duly authorized to bind the Roster Participant to the Terms and Conditions of Participation as indicated above.