QR Code Forms QR Empire Coffee Help Form Coffee QRWhat can we help you with today?- Select -Issue with equipment / Service RequestWe need suppliesSomething elseWe're here to helpPlease provide us with some information and we'll follow up.EmailFirst NameLast Name *Phone number where we can reach youCompany NameAddressAddress Line 1Address Line 2CityStateZip CodeLocation within buildingWhich coffee equipment is having issues?Please tell us about the issue you are experiencing and how we can serve you.Would you like to upload an image of the equipment? (optional)Choose File Please describe the issue you are experiencing and how we can serve you.Submit Form Empire Vending Machine Help Form Vending Machines QRWhat can we help you with today?- Select -Issue with equipment / Service RequestWe need suppliesRefund requestSomething elseWe're here to helpPlease provide us with some information and we'll follow up.Email AddressFirst NameLast Name *Phone number where we can reach youCompany NameAddressAddress Line 1Address Line 2CityStateZip CodeLocation within buildingWhich coffee equipment is having issues?Please tell us about the issue you are experiencing and how we can serve you.Would you like to upload an image of the equipment? (optional)Choose File Your phone numberWhat item did you have a problem with? *Please describe what happenedWould you like to upload a picture of the issue? (optional)Choose File How much was lost?What payment method did you use?- Select -CashCredit / Debit CardAppHow would you like to receive a refund?- Select -Cash AppVenmoPayPalPlease provide your Cash App IDPlease provide your Venmo IDPlease provide the email address associated with your PayPal accountPlease describe the issue you are experiencing and how we can serve you.Submit Form Empire Vending Micro Market Help Form Micro Markets QRWhat can we help you with today?- Select -Issue with equipment / Service RequestWe need suppliesRefund requestSomething elseWe're here to helpPlease provide us with some information and we'll follow up.EmailFirst NameLast Name *Phone number where we can reach youCompany NameAddressAddress Line 1Address Line 2CityStateZip CodeLocation within buildingWhich coffee equipment is having issues?Please tell us about the issue you are experiencing and how we can serve you.Would you like to upload an image of the equipment? (optional)Choose File Your phone numberFirst NameLast NameWhat item did you have a problem with?Please describe what happenedWould you like to upload a picture of the issue? (optional)Choose File How much was lost?What payment method did you use?- Select -CashCredit / Debit CardAppHow would you like to receive a refund?- Select -Cash AppVenmoPayPalPlease provide your Cash App IDPlease provide your Venmo IDPlease provide the email address associated with your PayPal accountPlease describe the issue you are experiencing and how we can serve you.Submit Form Empire Help Food Samplings V01 (#37)Company Name / LocationWhat Empire Fresh Food items did you try today?How would you rank the food options you tried today? 5 - Amazing! 4 - Great! 3 - Good 2 - Average 1 - BadDo you have any suggestions for our current or future fresh food menu options?How would you rank your overall Empire Vending experience? 5 - Amazing! 4 - Great! 3 - Good 2 - Average 1 - BadAdditional FeedbackSubmit Form
