Question Title

* 1. Legal Business Name

Question Title

* 2. Business Address

Question Title

* 3. City

Question Title

* 4. Zip Code

Question Title

* 5. Business Phone Number

Question Title

* 6. Phone Number for Coordinating Delivery

Question Title

* 7. First Name

Question Title

* 8. Last Name

Question Title

* 9. Title

Question Title

* 10. Phone Number

Question Title

* 11. Email

Question Title

* 12. Are you corporate owned?

Question Title

* 13. Do you have a valid permit from San Mateo County Environmental Health to operate?

Question Title

* 14. How many meals can you prepare for breakfast?

Question Title

* 15. How many meals can you prepare for lunch?

Question Title

* 16. How many meals can you prepare for dinner?

Question Title

* 17. Which days of the week can you prepare meals? (Check all that apply)

Question Title

* 18. What time of day can meals be picked up from your restaurant? (Check all that apply)

Question Title

* 19. What communities can you deliver to? (Check all that apply)

Question Title

* 20. Delivery drivers need to complete a background check as part of this program. If you have your own delivery drivers, do you screen your employees?

Question Title

* 21. Do you have a relationship(s) with a food delivery service that completes background checks?

Question Title

* 22. Are you able to follow the nutrition guidelines for this program (no sugary drinks-100% juice allowed, low sodium and one fruit/vegetable with each lunch/dinner entree)?*

Question Title

* 23. What else should we know about your restaurant's ability to serve meals to seniors?

T