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A trademark of Emeis Holdings Pty Ltd 25 Smith Street Fitzroy VIC 3065 Melbourne, Australia Telephone + 613 9412

8900 Facsimile + 613 9412 8990 Email aesop@aesop.net.au ABN 56 007 409 001

Australian Restaurant Enquiry Form Contact Details Name: Position: Restaurant name: Address: State: Postcode: Country: Telephone: Email: Retype Email: Website:

Questionnaire: Why are you interested in Aesop? Years in business/Opening date: Please describe your restaurant location in the context of adjacent businesses and other business within the street and surrounding area: Unique features and style of restaurant: Customer demographics:

Customer visits per day: Product lines currently offered (if any):

Anticipated Aesop offering: