Beta Tester Application

Consumer Testing Program

We count on consumer taste buds to develop our flavor products. That includes your taste buds. If you’re interested in joining our beta testing program, please fill out the application below.

Applicants must be at least 18 years of age and reside in the United States. Approved applicants agree to be contacted directly by email and/or phone (including text messages). Applicants who do not complete product feedback through the online submission form forfeit future participation in the program. By submitting this application, you certify that you meet these requirements and agree to these terms.

Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Birth Date

YYYY

Do you, or anyone in your household, have any food allergies or dietary restrictions that would prevent you from eating certain foods?

Yes

If yes - what should we refrain from sending you?

How did you hear about us? (If referred by a current beta tester, please write out their full name)

By checking this box, I acknowledge that, if chosen as a Beta Tester for Uncle Lumpy's Kitchen, I may be contacted periodically to test products and agree to this communication. Additionally, I agree to pay any associated shipping fees with the Beta Testing program prior to receiving any Beta Test items - and acknowledge and undertand that these fees are subject to change, with or without notice.

I AGREE