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* Please note: This form is for store owners interested in finding out more information about Krispy Krunchy® only. If you are a customer and would like to contact us, please use our customer contact form or call 1-800-290-6097.

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Owner Information

First Name*

Last Name*

Cell #*

Email*

STORE INFORMATION

Store Name*

Address*

Street Address City State / Province / Region ZIP / Postal Code Country

Store Phone #*

Brand of Gas

# of Locations

0–9 Digits Only

Length of Ownership

Merchandise sales per month*

Hours of Operation

FOOD SERVICE EQUIPMENT

Do you have the following food service equipment?

Do you have a Kitchen?*

Do you have a Hood?

Do you have a Three Compartment Sink?

What food are you currently selling?

SURROUNDING LOCATION

Any KKC locations nearby? Distance?

Quick service restaurants nearby?

Type of Location*

Demographics

How did you hear about our program?

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