Search Products / Suppliers

Membership Application

Questions? Email Us!
* Required Fields
Facility Information:
Facility Name: (Corporate Name or DBA, If applicable) *
Street Address: *
Mailing Address, if different from above:
City:* State:* Zip:*
Phone:* Fax:* E-mail Address:*
Web site Address:    
   
Billing Information, if different from above: Same as Above
Billing Contact First Name: Last Name:  
 
Title:  
Other:
Billing Address:
City: State: Zip:
     
Contact Information:
First Name:* Last Name:*  
 
Title: *    
Other:
Area of Responsibility: *    
Other:
Street Address: *
City: * State: * Zip: *
Phone: * Ext: Fax:
Fax Marketing Accepted: *
Cell Phone: 800 Number:  
 
E-mail Address: * Confirm E-mail Address: *  
 
E-mail Marketing Accepted: *
Preferred method of contact: *
     
Authorized Signature:
 By signing this application, Member hereby authorizes VGM Resorts and Gaming to offset any sums due Member, from VGM Resorts and Gaming, against any sums due VGM Resorts and Gaming.
First Name: * Last Name: *  
 
Title: *    
Other:
Main Contact First Name: * Last Name: *  
 
(Main contact will receive updates/mailings and be responsible for distribution of same)
Title: *
Other:
 
Date:* Fed ID#*  
 
     

Cash Back Advantage

  *Required Field.
Facility Name:*  
Federal ID#  
Name of Food Service Manager:*       Email:*
Name of Chef:       Email:_
Address:*  
City, St Zip:*   ,
Phone:*       Fax:*
VGM Club Member #  
   

Foodservice Distributors
Weekly Distributor purchases $:       No. of deliveries/week: 1   2   3   4
Primary:   Distributor:* Branch:*
Account #*   **
Secondary:   Distributor:    Branch:  
Account #     **
Secondary:   Distributor:    Branch:  
Account #     **
**You will normally find the account number on the upper left or right side of your invoices.
 
Provide both Account # and Customer # if different.
 
If any of the above accounts are under a name other than your club name,
please indicate:
Please provide a copy of one
invoice, front page ONLY,
from your Primary Distributor to eliminate
any data entry errors.
Fax to: 1-800-711-7785

If no Foodservice Distributors Deliver, please complete:
Snack Bar Only  
No Food Provided:  
Use Cash & Carry:  
Restaurant/Foodservice Leased:   ***
    ***Rebates may still be available. Call for details.
   

Kitchenwares Suppliers:
Weekly purchases
volume $: 		 
Primary:   Supplier: Branch:
Account#
Secondary:   Supplier: Branch:
Account#
   

Specialty Suppliers:
Coffee/Tea:   Supplier: Branch:
Account#
Soft Drink:   Supplier: Branch:
Account#
Are you currently part of a National Foodservice Distribution Program? Yes   No
    If yes, with whom?

Program (i.e. Avendra, Entegra, PAPC, Sysco Rewards, etc.):
 

I authorize VGM Resorts and Gaming to collect rebates on my behalf to be distributed quarterly. By submitting this form, Member hereby authorizes VGM Resorts and Gaming to offset any sums due to Member from VGM Resorts and Gaming against any sums due to VGM Resorts and Gaming. VGM Resorts and Gaming retains a portion of rebates earned for program administrative costs.

I HEREBY ACKNOWLEGE THAT I HAVE READ AND UNDERSTAND THE STATEMENT ABOVE

Signature:*   Date:*
     
 
Tyson Meats
 Cash Back Advantage
Cash Back Advantage 		Sprint-Nextel
 Gatorade

Toll Free: 800-363-5480
FAX: 800-711-7785
1111 W. San Marnan Dr. - Waterloo, IA 50701

SITE CREATED AND POWERED BY VGM FORBIN.
COPYRIGHT 2012: VGM Resorts and Gaming. ALL RIGHTS RESERVED.
Architecture and Interior Design Images Provided by Thiel and Thiel, Inc.