Riverco Vending
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Basic Intake Form
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Home
About Us
Our Services
Basic Intake Form
BASIC INTAKE FORM
We'd love to hear from you
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We constantly strive to bring you outstanding service that keeps your vending machines fully
stocked and running smoothly with premium payment solutions.
Send us a Message
DBA Name
*
Name on door/marketing material
Legal Business Name
*
Sole prop = First Last name of owner
Tax ID#
*
Sole prop usually SSN
Business entity type
*
Sole prop
C- Corp
S - Corp
LLC
Non profit
Business Address
*
Street Address
City
State
ZIP Code
Business Phone
*
Contact Email
*
[email protected]
Bank Name
*
Routing #
*
Account #
*
Gross Annual Sales Volume
*
Gross Annual Credit/Debit Card Volume
*
Average Ticket
*
High Ticket
*
Signor First Name
*
Signor Last Name
*
Signor Address
*
Street Address
City
State
ZIP Code
Owner email
*
Owner Cell
*
Signor SSN
*
Signor DL#
*
Signor DL issuing state
*
Date of birth
*
Date
Is there a 2nd owner?
*
Yes
No
Submit
Reach us through
Fort Myers, Florida
(239) 404-1743
[email protected]
Service areas
Lee County
Collier County
Charlotte County
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