First Name^*

Last Name^*

Title^*

Department

Category Manager Name (if applicable)

Company or Store Name^*

Store Number^*
(if you don’t have a store number put 0 in the box)

Store Address^*
(no P.O. Box numbers please)

City^*

State^*

Zip^*

Business Phone Number^*

Email^*

Number of Cash Registers in Your Store

Photo(s)/Video(s) of the Display

*** Photos of your Potato Lover's Display are mandatory, videos are optional. Acceptable file formats are .jpg, .png, .gif, .mp4, .wmv and .mov

^*REQUIRED
(Max file size 25MB)

(Max file size 25MB)

Please click the submit button only once.
Please be patient as the photos upload.
You will be taken to a confirmation screen when it has finished.