Restaurant Information
Restaurant / Company Name *
Address Line 1 *
Address Line 2
City *
State *	AL AK AR AZ CA CO CT DC DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY
Zip Code *
Number of Seats (Dining)
Number of Seats (Bar)
Hours of Operation
Contact Name *
Phone *
E-mail *
Cell Phone
Fax
Website
How did you hear about the Green Chicago Restaurant Co-op?
Please select one:	Current Distributor Internet Browsing College/Friend Green Event Other
Other:
What are your intentions for joining the Co-op?
Please select one:	I want to "go green" and don't know where to start! I have already started purchasing green products and want to do more. I am already a very green company and want to see how the Co-op can assist me in my efforts. I am interested in participating on the GCRC steering committee.
I am most interested in...
Please select two:	Green Disposables Green Paper Products Green Office Supplies Green Cleaning Products Energy Efficiency Composting Networking/Receiving updates on green events in Chicago
Please fill out the requested information:
Based on the information you provide, we will negotiate prices for the highest quality products available in the market and select a distributor. You will then be provided with all this information via email. Armed with this information you will be able to contact the distributor to get more information, request samples or purchase the product. You are NEVER under any obligation to buy.
Green Cleaning Supplies
Current Cleaning supplies/Dish soap Distributor:
Brand of cleaning supplies used
Brand of cleaning supplies used	EcoLab Other (Please specify)
Total # of meals served per week:
Green Disposables
Current Disposables Distributor:
Please indicate the number of items used per month for the following:
9 oz. clear plastic cold cup:
12 oz. clear plastic cold cup:
16 oz. clear plastic cold cup:
20 oz. clear plastic cold cup:
24 oz. clear plastic cold cup:
Knives, medium weight, plastic:
Forks, medium weight, plastic:
Spoons, medium weight, plastic:
6” plastic plate:
9” plastic plate:
10” plastic plate:
9”x9” clear plastic clamshell:
12 oz. hot cup:
16 oz. hot cup:
20 oz. hot cup:
Other, please describe:
Green Paper Supplies
Current Paper Products/Disposables Distributor:
Please indicate which of the following items you are interested in purchasing:
_______________________________________________
Paper hand towels:	Roll type Single fold Multi-fold Natural White
Number 325’ rolls used per month:
Number cases paper towels (4000/cs) used per month:
_______________________________________________
Paper bathroom tissue:	Jumbo roll Std Tissue 1 Ply 2 Ply
Number std tissue rolls (1210 sheets/roll) used per month:
Number jumbo rolls (2800’ sgl, 1400’ dbl) used per month:
_______________________________________________
Paper table napkins: Since there are so many types, please provide exact Cascades Tissue Group specification you would consider using. Refer to http://www.ctgebiz.cascades.com/BrandsRange.aspx?BrnId=NOR&LanId=2 for assistance with your specifications.
Table napkin description:
Number of paper napkins used per month:
_______________________________________________
Facial Tissue (flat box):
Number of boxes (100 sheets per box) used per month:
Waste Management
If you are interested recycling your waste, including organic waste, glass, grease,etc., please provide the information requested below. We will utilize this information to negotiate the best possible prices with local waste haulers who have proven themselves to be reliable, safe, and very conscientious in the proper handling of waste and recyclables. After negotiations are completed, a list of suppliers with their best prices and services will be made available to you. Providing the information requested below will not obligate you in any way to change from your current waste hauler.
Current Waste Hauler (to landfill):
Size and Quantity of dumpsters:
1 yard:
1.5 yard:
2 yard:
4 yard:
Number of pickups per week:
Days pickups are made:	Monday Tuesday Wednesday Thursday Friday Saturday Sunday
Time of pickup:
Do you currently separate cardboard?	Yes No
_______________________________________________
Current Grease Hauler:
Size and quantity of containers:
30 gallon drum:
55 gallon drum: