UIH FOOD

UIH FOOD MEMBERSHIP APPLICATION FORM
STAFF/INDIVIDUAL PACKAGE

1. PERSONAL DETAILS

Title: Mobile( 1):
Surname: Mobile(2):
First Name(s): Email:
Date of Birth: /D /M Company Name:
Residential Address: Position:
Office line:
Nationality: Office Address:


Do you consent to receive information from UIH FOOD via SMS and email YES/NO

2. STAFF/INDIVIDUAL FEEDING BUDGET

Daily limit N
Weekly limit N
Monthly limit N
Total amount budgeted for:

3. TICK METHOD OF PAYMENT

Deposit payment N
Daily { }
Weekly { }
Monthly { }
Choice of payment: Cheque,Cash&P.O.S

UIH FOOD

4. UIH FOOD PACKAGES

Staff package Mon To Fri { } Monthly { } Yearly { }
Company package Mon To Fri { } Monthly { } Yearly { }
Individual package Mon To Fri { } Monthly { } Yearly { }


5. FOOD & BEVERAGE TYPE

FOODS & BEVERAGE DAILY MON- FRI WEEKLY MONTHLY
Breakfast only
Lunch only
Breakfast & Lunch
Beverage only
Breakfast, Lunch & Beverage

6. MEMBERSHIP DECLARATION


Before signing this document, I have read, understand and hereby agree to the terms and conditions of membership as defined on the back of this membership form.

Name:
Sign: Date:

UIH FOOD
7. FOR OFFICE USE ONLY
Payment type:|Cash[ ] Cheque[ ]Visa[ ]Master card[ ]Bank transfer[ ]others[ ]
Amount Received: N…………………… Date paid/ / / /
Expiry date:/ / / /
Company name……………………………………………………..
Address………………………………………………………………….
Contact…………………………………………………………………..
Location…………………………………………………………………
Total staff………………………………………………………………
Budget…………………………………Limit………………………..
Deposit………………………………………………………………..
Method of payment………………………………………………
(Tick)
Company package [ ]
Staff package [ ]
Individual package [ ]

UIH staff Name…………………………………….. UIH management
Sign………………………..Date…………………….. Sign………………Date……….

UIH FOOD

4 Signature: Date: