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Vending Survey
Step
1
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2
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URL
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Business Name
*
Contact Name
*
First
Last
Phone Number
*
Email Address
*
Type of Facility:
*
Office Building
Hospital/Medical Office
Apartment/Condo
Fitness Center/Gym
School/College/University
Hotel/Motel
Manufacturing
# of Locations
Location Address(es)
# of Employees/Residents/Daily Clients
*
Under 50
50-100
100-200
200-300
300-400
400-500
500+
Current vending company, if any:
*
Do you have a contract with them?
*
Yes
No
Reason you are looking for a new vending company:
*
Date you are available for a site survey?
*
Are you looking for healthier food and beverage vending options?
Yes
No
Maybe
Which food categories important to you?
Organic
Vegan
Gluten-Free
Sugar-Free
All the above
None of the above
Which of the following does your current vending machine(s) accept?
Select All
$1
$5
$10
$20
Credit Cards
Debit Cards
Other contacts involved in vending machine decision, if any:
To help us understand your needs please choose min (3) of your favorites in each category. (ctrl+click to highlight multiple selections)
Beverages (select all that apply, min. 3)
*
POLAND SRPINGS 20 OZ
FIJI NATURAL ARTESIAN H20 16 OZ
BAI ANTIOXIDANT H20 18 OZ
VITAMIN WATER 20 OZ
VITAMIN WATER ZERO 20 OZ
RED BULL 12 OZ
RED BULL SUGAR FREE 12 OZ
CELSIUS 12 OZ
ALANU NU ENERGY 12 OZ
REIGN ENERGY DRINK 16 OZ
C4 SMART ENERGY DRINK 12 OZ
C4 ENERGY DRINK 16 OZ
MONSTER 16 OZ
MONSTER ZERO 16 OZ
STARBUCKS FRAPPUCINO 9.5 OZ
SNAPPLE ICED TEA 16 OZ
SNAPPLE ICED TEA DIET 16 OZ
ADAM & EVE ORANGE JUICE 10 OZ
ADAM & EVE APPLE JUICE 10 OZ
MUSCLE MILK NON-DAIRY CHOCO PROTEIN SHAKE 14 OZ
FAIRLIFE CHOCOLATE PROTEIN SHAKE 11 OZ
BAI ANTIOXIDANT H20 18 OZ
LEMON PERFECT H20 15 OZ
SNAPPLE ICED TEA 16 OZ
ARIZONA GREEN TEA 16 OZ
ARIZONA ARNOLD PALMER 16 OZ
MINUTE MAID LEMONADE
COCA-COLA CLASSIC
COCA-COLA ZERO
DIET COKE
MOUNTAIN DEW
SUNKIST ORANGE SODA
CANADA DRY GINGER ALE
SPRITE LEMON LIME SODA
DR PEPPER SODA
POPPI SODA 12 OZ
GATORADE 20 OZ
GATORADE ZERO 20 OZ
GATORADE FIT 16 OZ
GATORLYTE 20 OZ
PROPEL 16 OZ
Snacks (select all that apply, min. 3)
*
LAY'S CLASSIC POTATO CHIPS
LAY'S SOUR CREAM & ONION POTATO CHIPS
LAY'S BBQ POTATO CHIPS
LAY'S BAKED POTATO CHIPS
DORITOS NACHO CHEESE
DORITOS SPICY SWEET CHILI
CHEETOS CRUNCHY CHEESE
FRITOS
SMART FOOD POPCORN
SKINNY POP POPCORN
FAMOUS AMOS CHOCOLATE CHIP COOKIES
SENSIBLE PORTION GARDEN VEGGIE STRAWS 1 OZ
CHEEZ-IT ORIGINAL
GOLDFISH CRACKERS
CAPE COD KETTLE POTATO CHIPS
POPCHIPS POTATO CHIPS
POPCORNERS CORN CHIPS
SNYDER'S MINI PRETZELS
TAKI FUEGO ROLLED TORTILLA CHIPS
RITZ CHEESE BITES
POP-TARTS STRAWBERRY
POP-TARTS BROWN SUGAR
NATURE VALLEY SWEET & SALTY
KIND BARS
CLIF BARS
NUTRIGRAIN BARS
PLANTERS PEANUTS
PLANTERS TRAIL MIX
SECOND NATURE TRAIL MIX
ENTENMANN'S LITTLE BITE MUFFINS
DUCHESS HONEY BUN
Candy & Treats (select all that apply, min. 3)
*
REESE'S PEANUT BUTTER CUPS
SNICKERS
KITKAT
M&M'S MILK CHOCOLATE
M&M PEANUTS AND MILK CHOCOLATE
HERSHEY'S COOKIES & CREAM
TWIX
ALMOND JOY
SKITTLES
STARBURST ORIGINAL
SOUR PATCH KIDS WATERMELON
TROLLI SOUR BRITE CRAWLERS
NERDS GUMMY CLUSTERS
RICE KRISPIES
OREO 6 PACK
TRIDENT SPEARMINT GUM
Additional product recommendations:
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KM Dispensing Vending Services
State-of-the-art Vending For Your Business At Zero Cost To You
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Full Name
*
Business Name
*
Email
*
Phone Number
*
Daily Traffic / # of Employees
*
Message
*
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