Restaurant/Foodservice Operation Application

Primary Contact

First Name

Last Name

Address 1

Address 2

City

State

Zip

Title

Phone

Cell Phone

Restaurant Information

Company Name

Does your company have a different Mailing/Billing Address? NoYes

Mailing Address (if different)

Address 1

Address 2

City

State

Zip

Billing Address (if different)

Address 1

Address 2

City

State

Zip

Phone

Fax

Website

Industry Segment

Fine Dining
Casual/Family Dining
Quick Service
Other

Does your company have additional locations? NoYes

Additional Locations

Additional Location 1

First Name

Address 1

City

State

Zip

Additional Location 2

First Name

Address 1

Address 2

City

State

Zip

Additional Location 3

First Name

Address 1

Address 2

City

State

Zip

Additional Location 4

First Name

Address 1

Address 2

City

State

Zip

Additional Location 5

First Name

Address 1

Address 2

City

State

Zip

Referred By

What is your reason for joining?

Membership Investment

Membership Type

Primary Directory Category

Company Type

Independent
Corporation
Franchise

Tax Status

Sole Proprietorship
S-Corporation
LLC

Number of Locations

Number of Full Time Employees

Number of Seats (in all operations)

Year Business Opened

Type of Cuisine

Liquor License

Class AR
Class R
Class B

Annual Membership Investment

Your voluntary contribution of 10% of annual dues to the LRA Hospitality PAC is used to help elect pro-restaurant, pro-business and pro-free enterprise candidates for local municipalities, the Louisiana Legislature and those for statewide elected office.

Voluntary Contributions

Total Annual Membership Investment

The contents of this box are for testing purposes. This box will be removed when the form goes live.

Additional Items

Additional Directory Categories

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

Number of Associates

Millions in Assets

Tax

Number of Rooms

Additional Categories Cost

One-Time Application Fee

Number of Units

Number of Part Time Employees

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

Annual Dues (charged to card)

Revenue Item

Voluntary Contribution

Tax (charged to card)

Fee (charged to card)

Temp Value For DropDown 1

MembershipType

Enhanced Membership ($50)

Additional Item 2

Additional Item 3

Additional Item 4

Additional Item 5

Additional Item 6

Additional Item 7

Additional Item 8

Additional Item 9

Additional Item 10

How did you hear about us?

Address 1

Address 2

City

State

Zip

Payment Type

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 Information

Credit Card Type MastercardVisaDiscoverAmex

Credit Card Number

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

89 percent of your LRA dues is tax deductible

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

Please select a membership type before submitting your application.

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