New Customer Form

Bar / Restaurant Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Is this a New or Existing Establishment *

New

Existing

Name *

First Name

Last Name

Mobile Phone *

(###)

###

####

When would you like to begin the ice program? *

MM

DD

YYYY

Preferred Payment Method *

Check

Card Saved On File (We will charge per delivery)

Online (You will pay when the invoice is received online)

Earliest We Can Deliver *

Hour

Minute

Second

AM PM

Delivery Cutoff Time (if any)

Hour

Minute

Second

AM PM

Does your establishment require face masks to enter? *

Yes

No