Restaurant Application | Ohio Restaurant & Hospitality Alliance | Columbus, OH | [[Organization]]

Restaurant/DBA Name

Location Street Address 1

Location Street Address 2

City

Zip

Company/LLC Name

Federal Tax ID

Contact First Name

Contact Last Name

Title

Website

Company Street Address 1

Company Street Address 2

City

Zip

Phone

Fax

Preferred Method of Communication

E-Mail

Fax

Phone

Preferred Mailing

Location

Company

Name

First Name

Last Name

Address 1

Address 2

City

Zip

Email Address

First Name

Last Name

Address 1

Address 2

City

Zip

Email Address

First Name

Last Name

Address 1

Address 2

City

Zip

Email Address

First Name

Last Name

Address 1

Address 2

City

Zip

Email Address

First Name

Last Name

Address 1

Address 2

City

Zip

Email Address

First Name

Last Name

Address 1

Address 2

City

Zip

Email Address

First Name

Last Name

Address 1

Address 2

City

Zip

Email Address

First Name

Last Name

Address 1

Address 2

City

Zip

Email Address

First Name

Last Name

Address 1

Address 2

City

Zip

Email Address

First Name

Last Name

Address 1

Address 2

City

Zip

Email Address

# of units owned in Ohio

Ohio Bureau of Workers' Compensation Policy Number

Please provide quote for ORA Workers' Compensation Group Rating Plan

Yes

Year Opened

# Full-time Employees

# Part-time Employees

Seating Capacity

Your annual investment in the ORA is based on your gross sales volume. Please select the correct dues bracket according to sales volume. If your annual sales volume is $11,000,000 or over, please contact ORA for your investment amount at (800)282-9049.

Membership Type (By Annual Sales Volume)

Choose on PRIMARY Service Type

Choose on PRIMARY Cuisine Style

Carry Out
Catering
Delivery
Liquor License
Group Dining 1-20
Group Dining 21-49
Group Dining 50+

Promotional Code
* Codes are case sensitive

Primary Directory Category

Full-Time Employees

Part-Time Employees

Hotel/Motel Rooms

Restaurant Seats

Additional Associates

Additional Associates Cost

Additional Locations

Additional Locations Cost

Assets

Assets Cost

Additional Categories

Number Of Additional Categories

Additional Categories Cost

Additional Item 1 Cost

Additional Item 2 Cost

Additional Item 3 Cost

Additional Item 4 Cost

Additional Item 5 Cost

Additional Item 6 Cost

Additional Item 7 Cost

Additional Item 8 Cost

Additional Item 9 Cost

Additional Item 10 Cost

Promotional Code

Annual Dues (charged to card)

Revenue Item

Tax (charged to card)

Fee (charged to card)

Temp Value For DropDown 1

MembershipType

Primary Directory Category

Additional Directory Categories

Select additional directory categories below by holding the "CTRL" key
Secondary categories may be subject to additional fees

Number of Full Time Employees

Number of Part Time Employees

Number of Associates

Enhanced Membership ($50)

Annual Membership Investment

Additional Categories Cost

One-Time Application Fee

Annual Sales Volume (in millions)

NOTE: If selecting to pay by Check, please do not fill out the Credit Card Information section at the bottom of the form. Thanks.

Credit Card Type

Mastercard

Visa

Discover

Amex

Credit Card Number

Name on Card	Required
Security Code	Required
Valid Through
Address	Required
City	Required
State
Zip	Required
Phone	Required
Credit Card Email Address

Please click submit only one time. The transaction may take several seconds.