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Thank you again for your interest in operating a Ben & Jerry’s Scoop Shop. Please provide us with the information below. * = Required Field

Your Info:
*First Name:
*Last Name:
 Company Name:
*Street Address:
 
*City:
 State (if applicable)
 Zip/Postal Code:
*Country:
*Daytime Phone:
 Cell Phone:
 Fax:
*E-mail:
Market(s) of Interest:
First Choice:
   *City:
    State:
   *Country:
Second Choice:
    City:
    State:
    Country:

*What is your financial net worth, excluding primary residence?
0 to $199,999 $200,000 to $499,999
$500,000 to $999,999 over $1,000,000
*What is your liquid net worth?
0 to $199,999 $200,000 to $499,999
$500,000 to $999,999 over $1,000,000
*Are you interested in opening more than one Ben & Jerry’s location?
yes no
If “yes”, how many?
1 to 2 3 to 5 more than 5
What source first referred you to us?