First Name *

Last Name *

Mobile Phone *

Business Email *

Job Title *

Preferred Contact Method

Choose one or more options

Preferred Contact Time

Choose one or more options

Venue Information

Venue Name *

Address

Street Address *

City *

State *

Country *

Enter your country

Postal Code *

Venue Website *

Venue Instagram or Social Profile

What Type of Venue Do You Operate? *

Choose one or more options

Describe if Other:

How Long Has the Venue Been Operating? *

Select an option

Is your venue restricted to guests age 21 or older at all times?*

Select an option

How is guest age currently verified at entry?*

Choose one or more options

Does the venue currently hold a tobacco or nicotine retail license?

Select an option

What are your typical operating days?

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

Typical Opening Time

Typical Closing Time

Approximately how many guests visit your venue each week? *

What is your approximate venue capacity? *

When is your venue busiest? *

Weekday evenings

Friday Night

Saturday Night

Sunday events

Special events

Varies by week

Do you already have a potential location in mind for the machine?

Select an option

Where could the machine potentially be placed?

Choose one or more options

Is a standard electrical outlet available near the potential placement area?

Select an option

Is reliable Wi-Fi or Ethernet connectivity available inside the venue near the potential placement?

Select an option

Would the machine be located in an area visible to venue staff or security?

Select an option

Do guests currently ask staff where they can purchase vapes, nicotine pouches or similar products?

Select an option

Does your venue currently sell nicotine products?

Select an option

What are you most interested in?

Choose one or more options

I confirm that I am authorized to submit information on behalf of this venue.

I agree to be contacted by Afterwrk Vending by phone, email or text regarding venue eligibility, machine placement and scheduling.