DocuSign Envelope ID: 2895F6F7-0C07-4082-B28D-7A3FED594CAC

EXISTING EQUIPMENT APPROVAL – Latin America & The Caribbean

Section : DA/Franchisee/Store Information

Equipment going to restaurant#: ______________________ Restaurant # equipment is from: _______________________
Restaurant Address: ________________________________ City: ____________________ State/Province: ___________________
Country: _________________________________________ Zip Code: ______________________
BDA Name: ___________________________________________________________ BDA Contract #: ________________________
BDA Contact: ___________________________________________________________
Nathalia Mantilla Contact Email: _________________________
Franchise Owner Name: _______________________________________________________________________________________
Franchisee Owner Business E-Mail: _______________________________________________________________________________
Section : Service Area

Hot Unit: Age ________ Serial #: _____________________ Size: ___________________ LH/RH: ______________

Cold Unit: Age: ________ Unit 1 – Serial #: __________________________ Size:_____________________

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Age: ________ Unit 2 – Serial #: __________________________ Size:_____________________

Cash Counter: Serial #: ___________________ LH/RH: __________ Size – Length:_______________ Height: ____________

Cash Extension: Serial #: ___________________ LH/RH: __________ Size – Length:_______________ Height: ____________
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Beverage Extension: (inline with front counter)

Serial #: ___________________ LH/RH: __________ Size – Length:_______________ Height: ____________

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Speed Oven: Age: _________ Serial #: ___________________ Model: __________

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Microwave: Age: _________ Serial #: ___________________ Model: __________

Back Counters: Counter 1 – Serial #: __________________________ Size:_____________________ Type: _________________

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Counter 2 – Serial #: __________________________ Size:_____________________ Type: _________________

Counter 3 – Serial #: __________________________ Size:_____________________ Type: _________________

Counter 4 – Serial #: __________________________ Size:_____________________ Type: _________________

Counter 5 – Serial #: __________________________ Size:_____________________ Type: _________________

Hand Sink: Wall Mount: ___________ Counter:___________ LH/RH:___________ Counter size:__________________

Bread Oven: Age: _________ Serial #: ___________________ LH/RH: __________

Bread Cabinets: Type: _____________________ LH/RH: __________

Safe: Model: ___________________

Cooling Racks: Type: _____________________

Countertop Soup Warmer: Age: _________ Type: _____________

Countertop Food Warmer

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DocuSign Envelope ID: 2895F6F7-0C07-4082-B28D-7A3FED594CAC

Coffee: Brand: ____________________

Panini: Age: _________ Manufacturer: ______________________________ Model: __________________

Potato Warmer: Age: _________ Manufacturer: ______________________________ Model: __________________

MEA Only

Fresh Forward Frontline Soup Counter:

Age: _____ Manufacturer: ________________ LH/RH:______ Serial #:_________________ Size: ________

Fresh Forward Front Line Bread Cabinet:

Manufacturer: ____________________ LH/RH:___________ Serial #:_______________

Fresh Display: Age: _________ Manufacturer: ____________________ Serial #: ______________________

Valance/Shroud: Manufacturer: ____________________ Size: _________________________

Digital Menuboards: Manufacturer: ____________________ Size: _________________________ Quantity: __________________

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Pick-Up Shelf: Manufacturer: ____________________

*For LATAM Countries Only*

Food Theater (Sauté Counter): Serial #: _________________________________ Size: _____________________
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Induction Burner: Serial #: _________________________________ Size: _____________________

Section : Backroom
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Cooler: Age: _________ Serial #: ___________________ Type: _________________ # of Doors: ______________

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Size – Length: ______________ Height: ________________ Quantity: __________________

Freezer: Age: _________ Serial #: ___________________ Type: _________________ # of Doors: ______________

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Size – Length: ______________ Height: ________________ Quantity: ________________

Retarder: Type: _________________

Hand Sink

Veggie Sink: # of Drainboards: ___________ Drainboard Size: _________

3-comp Sink: # of Drainboards: ___________ Drainboard Size: _________

Stainless Steel Prep Table:

Size: ______________________

Backroom Make Station:

Age: _________ Serial #: ________________________________ Size: ______________________

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DocuSign Envelope ID: 2895F6F7-0C07-4082-B28D-7A3FED594CAC

Smartwall: Sizes – ____________________ ____________________ ____________________ ____________________

Wall Shelf: Sizes – ____________________ ____________________ ____________________ ____________________

Dry Storage: Manufacturer: ___________________________ Model: _____________________

Unit 1 – Size - Length: _____________________ Height: _____________________

Unit 2 – Size - Length: _____________________ Height: _____________________

Unit 3 – Size - Length: _____________________ Height: _____________________

Unit 4 – Size - Length: _____________________ Height: _____________________

Dish Machine: Manufacturer: ___________________________ Model: _____________________

Slicers: Type: _______________________

Section : Customer Area

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Dining Chairs: Manufacturer: ___________________________ # of Yellow: ______________ # of Silver: ______________

Dining Stools: Manufacturer: ___________________________ # of Yellow: ______________ # of Silver: ______________

Ottomans: Manufacturer: ___________________________ Quantity: ________________

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Arm Chairs: Manufacturer: ___________________________ Quantity: ________________

Table Frames: Manufacturer: ___________________________ Quantity – 30” High: ___________ 42” High: ____________
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Table Tops: Manufacturer: ___________________________

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Quantity – 20x24: Beigewood: ______________________ Vapor Strandz: ______________________

42x30: Beigewood: ______________________ Vapor Strandz: ______________________

36” Round: Beigewood: __________________

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30” Round: Beigewood: __________________

24x60: Beigewood: ______________________

24x44: Beigewood: ______________________

Communal Tables: Quantity – Beigewood: __________ Vapor Strandz: __________ Size – Length: __________ Height: __________

Dining Counters: Type: _________________________ Size: __________________

Wall Benches: Quantity: ______________________ Size: __________________

Wood Plank Focal Wall: # of Panels: ______________ Size: __________________

ChoiceMark: Manufacturer: ___________________________ Size: __________________

Wall Art: Manufacturer: ___________________________ Quantity: ______________

Brand Messaging: Manufacturer: ___________________________

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DocuSign Envelope ID: 2895F6F7-0C07-4082-B28D-7A3FED594CAC

Beverage Counter:
Serial #: _______________________ Cutout: _____________ Size – Length: ___________ Depth: ___________

Fountain Dispenser:
Age: _________ Serial #: _______________________ Model #: _______________________

Ice Machine: Age: _________ Serial #: ___________________ Manufacturer: _________________ Model #: _______________

Bottle Beverage Cooler:

Age: _________ Serial #: ____________________ Manufacturer: ________________ Model: _______________

Size: ______________________________

Pergola Light: Manufacturer: ___________________________ Size: __________________

Signage: Exterior: ________________________________ Manufacturer: __________________________

Interior: ________________________________ Manufacturer: __________________________

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Open Sign: ______________________________ Manufacturer: __________________________

Please include photos of ALL equipment/décor items noted above to support this request.
Attachments
When attaching pictures, please remember:
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 Files shouldn’t be too large

 JPEG or TIFF files are good

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Photos should be clear and taken at a slight distance

 Photos to be labeled nnnnnColdUnit.ext (nnnnn represents restaurant #)
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 Also attach the Health Check or Service Agent Report for refrigeration systems and ovens
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Section : Decision

Used Equipment Approval Decision: ________________________________ Decision Date: __________________

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