2012 Economic Census Covering the Retail Trade and Accommodation and Food Services Sectors

Attachment C-4
2012 Economic Census
Retail Trade and Accommodation and Food Services Sectors
Variable Content for Item 26 – Special Inquiries

RT-44101
#L SOLD OR LEASED VEHICLES
1. Leased motor vehicles

Mark "X"
if None $ Bil.

a. Fair sales value of leased motor vehicles for this establishment
(Include the fair sales value of leases marketed in 2012, regardless
of whether this establishment held them.) . . . . . . . . . . . .

2160

b. Motor vehicle lease payments received by this establishment . . .

2161

2012
Mil.

2012
Number

2. Number of units sold or leased by this establishment for each of the following types of
vehicles:
a. New passenger cars sold

Thou.

. . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2162

b. Used passenger cars sold . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2163

c. New passenger cars leased

. . . . . . . . . . . . . . . . . . . . . . . . . . . .

2164

d. New vans and trucks sold . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2165

e. Used vans and trucks sold . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2166

f. New vans and trucks leased . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2167

g. Used passenger cars, vans, and trucks leased . . . . . . . . . . . . . . . . . . . .

2168

h. TOTAL (Sum of lines 2a through 2g) . . . . . . . . . . . . . . . . . . . . . . . .

2169

Dol.

RT-44101
#L FRANCHISE
1.

Was this establishment operating under a trademark(s) authorized by a franchisor in 2012?
(Mark "X" only ONE box.)

0237

Yes - franchisee-owned establishment

0238

Yes - franchisor-owned establishment

0239

No

2.

0236

If yes, provide the trademark(s) below.

RT-44102
#L BOAT FACILITIES
Boat dealers only
Number of pleasure boat docking or storage spaces, including wet slips, moorings,
in/out racks, and other land storage spaces, that this establishment had as of
December 31, 2012 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Mark "X"
if None

2200

2012
Number as of
December 31

RT-44102
#L FRANCHISE
1.

Was this establishment operating under a trademark(s) authorized by a franchisor in 2012?
(Mark "X" only ONE box.)

0237

Yes - franchisee-owned establishment

0238

Yes - franchisor-owned establishment

0239

No

2.

0236

If yes, provide the trademark(s) below.

RT-44103
#L REPAIR
2012
Mark "X" Number for the pay
if None
period including
March 12

1. Number of mechanics (full- and part-time) working in this establishment during
the pay period including March 12, 2012 . . . . . . . . . . . . . . . . . . . .

2175

Mark "X"
if None

2. Number of automotive service bays at this establishment as of December 31,
2012 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2180

2012
Number as of
December 31

RT-44103
#L RETREADING TIRES
Was 50 percent or more of this establishment's sales and receipts (reported in
at THIS establishment?
2191

Yes

2192

No

?

) derived from RETREADING tires

RT-44103
#L FRANCHISE
1.

Was this establishment operating under a trademark(s) authorized by a franchisor in 2012?
(Mark "X" only ONE box.)

0237

Yes - franchisee-owned establishment

0238

Yes - franchisor-owned establishment

0239

No

2.

0236

If yes, provide the trademark(s) below.

RT-44201
#L USED MERCHANDISE
Did the sale of used or secondhand merchandise, including antiques and collectibles, account for more than
75 percent of the total sales and receipts reported in ? ?
2101

Yes

2102

No

RT-44201
#L FRANCHISE
1.

Was this establishment operating under a trademark(s) authorized by a franchisor in 2012?
(Mark "X" only ONE box.)

0237

Yes - franchisee-owned establishment

0238

Yes - franchisor-owned establishment

0239

No

2.

0236

If yes, provide the trademark(s) below.

RT-44202
#L USED MERCHANDISE
Did the sale of used or secondhand merchandise, including antiques and collectibles, account for more than
75 percent of the total sales and receipts reported in ? ?
2101

Yes

2102

No

RT-44202
#L FRANCHISE
1.

Was this establishment operating under a trademark(s) authorized by a franchisor in 2012?
(Mark "X" only ONE box.)

0237

Yes - franchisee-owned establishment

0238

Yes - franchisor-owned establishment

0239

No

2.

0236

If yes, provide the trademark(s) below.

RT-44301
#L USED MERCHANDISE
Did the sale of used or secondhand merchandise, including antiques and collectibles, account for more than
75 percent of the total sales and receipts reported in ? ?
2101

Yes

2102

No

RT-44301
#L FRANCHISE
1.

Was this establishment operating under a trademark(s) authorized by a franchisor in 2012?
(Mark "X" only ONE box.)

0237

Yes - franchisee-owned establishment

0238

Yes - franchisor-owned establishment

0239

No

2.

0236

If yes, provide the trademark(s) below.

RT-44401
#L FRANCHISE
1.

Was this establishment operating under a trademark(s) authorized by a franchisor in 2012?
(Mark "X" only ONE box.)

0237

Yes - franchisee-owned establishment

0238

Yes - franchisor-owned establishment

0239

No

2.

0236

If yes, provide the trademark(s) below.

RT-44402
#L ITEMS GROWN
2012
Mark "X" Whole percent
if None of sales and
receipts

Percentage of sales and receipts (reported in ? ) that was derived from items grown by this
establishment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2125

%

RT-44402
#L FRANCHISE
1.

Was this establishment operating under a trademark(s) authorized by a franchisor in 2012?
(Mark "X" only ONE box.)

0237

Yes - franchisee-owned establishment

0238

Yes - franchisor-owned establishment

0239

No

2.

0236

If yes, provide the trademark(s) below.

RT-44501
#L EXCISE TAX
Mark "X"
if None

1. Estimated amount of excise taxes on items such as gasoline, liquor, and
tobacco sold by this establishment . . . . . . . . . . . . . . . . . . . .
2. Are excise taxes included in sales and receipts (reported in
2156

Yes

2157

No

?

)?

2150

$ Mil.

2012
Thou.

Dol.

RT-44501
#L FLOOR SPACE
Include:
• Only the floor space used/controlled by this company.
• All space occupied by this establishment on every floor of multi-story buildings.
EXAMPLE: How to compute floor space in square feet
(1) Under-roof selling space is:
200 ft. x 80 ft. = 16,000 sq. ft.
(2) Total under-roof floor space is:
200 ft. x 100 ft. = 20,000 sq. ft.

100 ft.

Selling space

Office

80 ft.

Storage
200 ft.
2012

1. Under-roof selling space
(Enter the square footage of in-store selling space at the end of 2012. Include all store
areas open to customers, including aisles, elevators, etc. Exclude display windows
fronting onto streets or walks, outdoor entrance ways, or other outdoor space.) . . . .
2.

Total under-roof floor space
(Enter the total square footage of all under-roof selling space plus all other space
available at the end of 2012. Include dry storage, refrigerated space, offices,
workrooms, display windows, and enclosed entrance ways. Exclude outdoor space,
even if covered.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Square feet as of
December 31
2111

2110

RT-44501
#L FRANCHISE
1.

Was this establishment operating under a trademark(s) authorized by a franchisor in 2012?
(Mark "X" only ONE box.)

0237

Yes - franchisee-owned establishment

0238

Yes - franchisor-owned establishment

0239

No

2.

0236

If yes, provide the trademark(s) below.

RT-44601
#L FRANCHISE
1.

Was this establishment operating under a trademark(s) authorized by a franchisor in 2012?
(Mark "X" only ONE box.)

0237

Yes - franchisee-owned establishment

0238

Yes - franchisor-owned establishment

0239

No

2.

0236

If yes, provide the trademark(s) below.

RT-44701
#L EXCISE TAX
Mark "X"
if None

1. Estimated amount of excise taxes on items such as gasoline, motor fuel
propane, liquor, and tobacco sold by this establishment . . . . . . . . . .
2. Are excise taxes included in sales and receipts (reported in
2156

Yes

2157

No

?

)?

2150

$ Mil.

2012
Thou.

Dol.

RT-44701
#L FUEL
Mark "X"
if None

1. Number of gallons of gasoline sold

. . . . . . . . . . . . . . . . . . .

2210

2. Number of gallons of other automotive fuels, including diesel, sold . . . .

2215

2012
Number

RT-44701
#L REPAIR
2012
Mark "X" Number for the pay
if None
period including
March 12

1. Number of mechanics (full- and part-time) working in this establishment during
the pay period including March 12, 2012 . . . . . . . . . . . . . . . . . . . .

2175

Mark "X"
if None

2. Number of automotive service bays at this establishment as of December 31,
2012 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2180

2012
Number as of
December 31

RT-44701
#L FUEL PUMPS
Did this establishment have public-access fuel pumps in 2012?
1217

Yes

1218

No

RT-44701
#L INTRACOMPANY TRANSFERS
1. Did any of the sales reported in ? include the value of transfers to other company-owned gasoline stations,
fuel oil dealers, and liquefied petroleum (LP) gas dealers?
1211

Yes

1212

No - Go to line F

2. Value of transfers to other company-owned gasoline stations, fuel oil
dealers, and liquefied petroleum (LP) gas dealers . . . . . . . . . .

Mark "X"
if None $ Bil.
1213

2012
Mil.

Thou.

Dol.

RT-44701
#L BULK PETROLEUM
Did this establishment have bulk petroleum (automotive gas, diesel, propane, etc.) storage capacity of more than
60,000 gallons in 2012?
1221

Yes

1222

No

RT-44701
#L FRANCHISE
1. Was this establishment operating under a trademark(s) or brand name(s) authorized by a franchisor in 2012?
(Mark "X" only ONE box.)
0237

Yes - franchisee-owned establishment

0238

Yes - franchisor-owned establishment

0239

No

2. If yes, provide the trademark(s) or brand(s) name below.

0236

RT-44801
#L USED MERCHANDISE
Did the sale of used or secondhand merchandise account for more than 75 percent of the total sales and receipts
reported in ? ?
2101

Yes

2102

No

RT-44801
#L MADE-TO-ORDER
Were more than half of this establishment's sales and receipts (reported in
garments MADE TO CUSTOMER'S ORDER?
2221

Yes

2222

No

?

) derived from sales of

RT-44801
#L

FRANCHISE
1. Was this establishment operating under a trademark(s) authorized by a franchisor in 2012?
(Mark "X" only ONE box.)
0237

Yes - franchisee-owned establishment

0238

Yes - franchisor-owned establishment

0239

No

2. If yes, provide the trademark(s) below.

0236

RT-44802
#L CONCESSION
Did this establishment conduct business as a department or concession in an establishment operated by another
firm in 2012?
2241

Yes

2242

No

RT-44802
#L

FRANCHISE
1. Was this establishment operating under a trademark(s) authorized by a franchisor in 2012?
(Mark "X" only ONE box.)
0237

Yes - franchisee-owned establishment

0238

Yes - franchisor-owned establishment

0239

No

2. If yes, provide the trademark(s) below.

0236

RT-44803
#L USED MERCHANDISE
Did the sale of used or secondhand merchandise, including antiques and collectibles, account for more than
75 percent of the total sales and receipts reported in ? ?
2101

Yes

2102

No

RT-44803
#L

FRANCHISE
1. Was this establishment operating under a trademark(s) authorized by a franchisor in 2012?
(Mark "X" only ONE box.)
0237

Yes - franchisee-owned establishment

0238

Yes - franchisor-owned establishment

0239

No

2. If yes, provide the trademark(s) below.

0236

RT-45101
#L USED MERCHANDISE
Did the sale of used or secondhand merchandise account for more than 75 percent of the total sales and receipts
reported in ? ?
2101

Yes

2102

No

RT-45101
#L

FRANCHISE
1. Was this establishment operating under a trademark(s) authorized by a franchisor in 2012?
(Mark "X" only ONE box.)
0237

Yes - franchisee-owned establishment

0238

Yes - franchisor-owned establishment

0239

No

2. If yes, provide the trademark(s) below.

0236

RT-45102
#L

FRANCHISE
1. Was this establishment operating under a trademark(s) authorized by a franchisor in 2012?
(Mark "X" only ONE box.)
0237

Yes - franchisee-owned establishment

0238

Yes - franchisor-owned establishment

0239

No

2. If yes, provide the trademark(s) below.

0236

RT-45103
#L USED MERCHANDISE
Did the sale of used or secondhand merchandise, including antiques and collectibles, account for more than
75 percent of the total sales and receipts reported in ? ?
2101

Yes

2102

No

RT-45103
#L

FRANCHISE
1. Was this establishment operating under a trademark(s) authorized by a franchisor in 2012?
(Mark "X" only ONE box.)
0237

Yes - franchisee-owned establishment

0238

Yes - franchisor-owned establishment

0239

No

2. If yes, provide the trademark(s) below.

0236

RT-45104
#L USED MERCHANDISE
Did the sale of used or secondhand merchandise, including antiques and collectibles, account for more than
75 percent of the total sales and receipts reported in ? ?
2101

Yes

2102

No

RT-45104
#L

FRANCHISE
1. Was this establishment operating under a trademark(s) authorized by a franchisor in 2012?
(Mark "X" only ONE box.)
0237

Yes - franchisee-owned establishment

0238

Yes - franchisor-owned establishment

0239

No

2. If yes, provide the trademark(s) below.

0236

RT-45201
#L FLOOR SPACE
Include:
• Only the floor space used/controlled by this company.
• All space occupied by this establishment on every floor of multi-story buildings.
EXAMPLE: How to compute floor space in square feet
(1) Under-roof selling space is:
200 ft. x 80 ft. = 16,000 sq. ft.
(2) Total under-roof floor space is:
200 ft. x 100 ft. = 20,000 sq. ft.

100 ft.

Selling space

Office

80 ft.

Storage
200 ft.
2012

1. Under-roof selling space
(Enter the square footage of in-store selling space at the end of 2012. Include all store
areas open to customers, including aisles, elevators, etc. Exclude display windows
fronting onto streets or walks, outdoor entrance ways, or other outdoor space.) . . . .
2.

Total under-roof floor space
(Enter the total square footage of all under-roof selling space plus all other space
available at the end of 2012. Include dry storage, refrigerated space, offices,
workrooms, display windows, and enclosed entrance ways. Exclude outdoor space,
even if covered.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Square feet as of
December 31
2111

2110

RT-45201
#L CENTRALIZED CHECKOUT
Did this establishment have a CENTRALIZED check-out area with MULTIPLE cash registers in 2012?
2131

Yes

2132

No

RT-45201
#L

FRANCHISE
1. Was this establishment operating under a trademark(s) authorized by a franchisor in 2012?
(Mark "X" only ONE box.)
0237

Yes - franchisee-owned establishment

0238

Yes - franchisor-owned establishment

0239

No

2. If yes, provide the trademark(s) below.

0236

RT-45202
#L FLOOR SPACE
Include:
• Only the floor space used/controlled by this company.
• All space occupied by this establishment on every floor of multi-story buildings.
EXAMPLE: How to compute floor space in square feet
(1) Under-roof selling space is:
200 ft. x 80 ft. = 16,000 sq. ft.
(2) Total under-roof floor space is:
200 ft. x 100 ft. = 20,000 sq. ft.

100 ft.

Selling space

Office

80 ft.

Storage
200 ft.
2012

1. Under-roof selling space
(Enter the square footage of in-store selling space at the end of 2012. Include all store
areas open to customers, including aisles, elevators, etc. Exclude display windows
fronting onto streets or walks, outdoor entrance ways, or other outdoor space.) . . . .
2.

Total under-roof floor space
(Enter the total square footage of all under-roof selling space plus all other space
available at the end of 2012. Include dry storage, refrigerated space, offices,
workrooms, display windows, and enclosed entrance ways. Exclude outdoor space,
even if covered.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Square feet as of
December 31
2111

2110

RT-45202
#L CENTRALIZED CHECKOUT
Did this establishment have a CENTRALIZED check-out area with MULTIPLE cash registers in 2012?
2131

Yes

2132

No

RT-45202
#L

FRANCHISE
1. Was this establishment operating under a trademark(s) authorized by a franchisor in 2012?
(Mark "X" only ONE box.)
0237

Yes - franchisee-owned establishment

0238

Yes - franchisor-owned establishment

0239

No

2. If yes, provide the trademark(s) below.

0236

RT-45301
#L ITEMS GROWN
2012
Mark "X" Whole percent
if None of sales and
receipts

Percentage of sales and receipts (reported in ? ) that was derived from items grown by this
establishment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2125

%

RT-45301
#L

FRANCHISE
1. Was this establishment operating under a trademark(s) authorized by a franchisor in 2012?
(Mark "X" only ONE box.)
0237

Yes - franchisee-owned establishment

0238

Yes - franchisor-owned establishment

0239

No

2. If yes, provide the trademark(s) below.

0236

RT-45302
#L

FRANCHISE
1. Was this establishment operating under a trademark(s) authorized by a franchisor in 2012?
(Mark "X" only ONE box.)
0237

Yes - franchisee-owned establishment

0238

Yes - franchisor-owned establishment

0239

No

2. If yes, provide the trademark(s) below.

0236

RT-45304
#L USED MERCHANDISE
Did the sale of used or secondhand merchandise, including antiques and collectibles, account for more than
75 percent of the total sales and receipts reported in ? ?
2101

Yes

2102

No

RT-45304
#L

FRANCHISE
1. Was this establishment operating under a trademark(s) authorized by a franchisor in 2012?
(Mark "X" only ONE box.)
0237

Yes - franchisee-owned establishment

0238

Yes - franchisor-owned establishment

0239

No

2. If yes, provide the trademark(s) below.

0236

RT-45305
#L

FRANCHISE
1. Was this establishment operating under a trademark(s) authorized by a franchisor in 2012?
(Mark "X" only ONE box.)
0237

Yes - franchisee-owned establishment

0238

Yes - franchisor-owned establishment

0239

No

2. If yes, provide the trademark(s) below.

0236

RT-45306
#L EXCISE TAX
Mark "X"
if None

1. Estimated amount of excise taxes on items such as gasoline, liquor, and
tobacco sold by this establishment . . . . . . . . . . . . . . . . . . . .
2. Are excise taxes included in sales and receipts (reported in
2156

Yes

2157

No

?

)?

2150

$ Mil.

2012
Thou.

Dol.

RT-45306
#L

FRANCHISE
1. Was this establishment operating under a trademark(s) authorized by a franchisor in 2012?
(Mark "X" only ONE box.)
0237

Yes - franchisee-owned establishment

0238

Yes - franchisor-owned establishment

0239

No

2. If yes, provide the trademark(s) below.

0236

RT-45307
#L USED MERCHANDISE
Did the sale of used or secondhand merchandise, including antiques and collectibles, account for more than
75 percent of the total sales and receipts reported in ? ?
2101

Yes

2102

No

RT-45307
#L

FRANCHISE
1. Was this establishment operating under a trademark(s) authorized by a franchisor in 2012?
(Mark "X" only ONE box.)
0237

Yes - franchisee-owned establishment

0238

Yes - franchisor-owned establishment

0239

No

2. If yes, provide the trademark(s) below.

0236

RT-45360
#L USED MERCHANDISE
Did the sale of used or secondhand merchandise, including antiques and collectibles, account for more than
75 percent of the total sales and receipts reported in ? ?
2101

Yes

2102

No

RT-45360
#L

FRANCHISE
1. Was this establishment operating under a trademark(s) authorized by a franchisor in 2012?
(Mark "X" only ONE box.)
0237

Yes - franchisee-owned establishment

0238

Yes - franchisor-owned establishment

0239

No

2. If yes, provide the trademark(s) below.

0236

RT-45401
#L VENDING MACHINE
2012
Mark "X" Whole percent
if None of sales and
receipts

1. Percentage of this establishment's sales and receipts (reported in ? ) derived from
merchandise vending machines SERVICED BY THIS ESTABLISHMENT . . . . . . . . .

%

2370

2012

2. Percentage of total sales and receipts (reported in
items through merchandise vending machines

?

Whole percent
of sales and
receipts

) derived from the sale of the following

a. Tobacco . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2371

b. Meals and snacks

2372

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

c. Beverages (soft drinks, milk, coffee, tea, etc.)

. . . . . . . . . . . . . . . . . . . . . .

2373

d. Other merchandise (nonedible) . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2374

e. TOTAL (Sum of lines 2a through 2d should equal percentage reported on line 1) . . . . .

2375

%
%
%
%
%

RT-45402
#L EXCISE TAX
Mark "X"
if None

1. Estimated amount of excise taxes on items such as gasoline, motor fuel
propane, liquor, and tobacco sold by this establishment . . . . . . . . . .
2. Are excise taxes included in sales and receipts (reported in
2156

Yes

2157

No

?

)?

2150

$ Mil.

2012
Thou.

Dol.

RT-45402
#L FUEL PUMPS
Did this establishment have public-access fuel pumps in 2012?
1217

Yes

1218

No

RT-45402
#L INTRACOMPANY TRANSFERS
1. Did any of the sales reported in ? include the value of transfers to other company-owned gasoline stations,
fuel oil dealers, and liquefied petroleum (LP) gas dealers?
1211

Yes

1212

No - Go to line D

2. Value of transfers to other company-owned gasoline stations, fuel oil
dealers, and liquefied petroleum (LP) gas dealers . . . . . . . . . .

Mark "X"
if None $ Bil.
1213

2012
Mil.

Thou.

Dol.

RT-45402
#L BULK PETROLEUM
Did this establishment have bulk petroleum (automotive gas, diesel, propane, etc.) storage capacity of more than
60,000 gallons in 2012?
1221

Yes

1222

No

RT-45402
#L FRANCHISE
1. Was this establishment operating under a trademark(s) or brand name(s) authorized by a franchisor in 2012?
(Mark "X" only ONE box.)
0237

Yes - franchisee-owned establishment

0238

Yes - franchisor-owned establishment

0239

No

2. If yes, provide the trademark(s) or brand(s) name below.

0236

AF-72101
#L ROOMS
(The number of guestrooms, units, or quarters consists of the number that can be rented as single units. Suites of
rooms that cannot be subdivided should be counted as a single unit.)
2012
Number as of
December 31

Number of rooms, units, or quarters, by type
1. Primarily rented as residential quarters or units (occupied as one's primary residence)

.

2401

2. Primarily rented as transient guestrooms or units . . . . . . . . . . . . . . . . . . .

2402

3. TOTAL (Sum lines 1 and 2) . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2400

AF-72101
#L

FRANCHISE
1. Was this establishment operating under a trademark(s) authorized by a franchisor in 2012?
(Mark "X" only ONE box.)
0237

Yes - franchisee-owned establishment

0238

Yes - franchisor-owned establishment

0239

No

2. If yes, provide the trademark(s) below.

0236

AF-72102
#L ROOMS
(The number of guestrooms, units, or quarters consists of the number that can be rented as single units. Suites of
rooms that cannot be subdivided should be counted as a single unit.)
2012
Number as of
December 31

Number of rooms, units, or quarters, by type
1. Primarily rented as residential quarters or units (occupied as one's primary residence)

.

2401

2. Primarily rented as transient guestrooms or units . . . . . . . . . . . . . . . . . . .

2402

3. TOTAL (Sum lines 1 and 2) . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2400

AF-72102
#L

FRANCHISE
1. Was this establishment operating under a trademark(s) authorized by a franchisor in 2012?
(Mark "X" only ONE box.)
0237

Yes - franchisee-owned establishment

0238

Yes - franchisor-owned establishment

0239

No

2. If yes, provide the trademark(s) below.

0236

AF-72201
#L FOOD SERVICE
1. Type of food service
(Mark "X" only ONE box that represents the primary type of service from which this establishment derived the
largest share of its sales (reported in ? ) in 2012.)
2251

Table, booth, and/or counter seats with waiter or waitress service

2252

Order and pay at counter with SEPARATE inside seating provided

2253

Take out/drive through

2254

Delivery

2255

Cafeteria line with SEPARATE inside seating provided

2256

Other - Specify
0820

2. Estimated average price per meal, excluding tax and tip
(Mark "X" only ONE box.)
2261

Under $5.00

2265

$15.00 - $19.99

2262

$5.00 - $6.99

2266

$20.00 - $29.99

2263

$7.00 - $9.99

2267

$30.00 - $49.99

$10.00 - $14.99
$50.00 or more
2268
3. Number of seats in this establishment as of December 31, including bar and patio
seats . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Mark "X"
if None

2264

2012
Number as of
December 31

2270

4. Did a waiter or waitress take most orders while the patron was seated?
2281

Yes

2282

No

5. Principal menu type
(Mark "X" only ONE box which best describes the principal menu type (specialty) of this establishment.)
2301

Italian (If primarily pizza, mark "X" only 'Pizza'.)

2302

Mexican

2303

Chinese

2304

Other ethnic specialty

2305

Seafood

2306

Steak

2307

Pizza

2308

Chicken

2309

Hamburgers

2310

Sandwich/sub shop

2311

Other food specialty (barbeque, vegetarian, ice cream/yogurt shop, etc.)

2312

No food specialty (none of the above food types should account for more than 50 percent of the menu)

AF-72201
2012
Percent

6. Percentage of this establishment's food and beverage sales by day-part
(Report in whole percents; estimates are acceptable.)
a. 6:00 a.m. - 11:00 a.m. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2320

b. 11:00 a.m. - 5:00 p.m. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2321

c. 5:00 p.m. - 11:00 p.m. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2322

d. 11:00 p.m. - 6:00 a.m. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2323

e. TOTAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

%
%
%
%

1 0 0 %

AF-72201
#L CONCESSION
Was this establishment operated as a concession in a stadium, arena, or other recreation or amusement place at
which food was made available to the general public in 2012?
2231

Yes

2232

No

AF-72201
#L

FRANCHISE
1. Was this establishment operating under a trademark(s) authorized by a franchisor in 2012?
(Mark "X" only ONE box.)
0237

Yes - franchisee-owned establishment

0238

Yes - franchisor-owned establishment

0239

No

2. If yes, provide the trademark(s) below.

0236

AF-72202
#L CONTRACT FEEDING
2012

1. Percentage of this establishment's total sales and receipts (reported in ? ) from
providing food service UNDER CONTRACT to another company; a hospital; or a
governmental, penal, or educational institution to feed its employees, patients, inmates,
passengers, students, etc. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Mark "X" Whole percent
if None of sales and
receipts

%

2350

2012

2. Percentage of this establishment's total sales and receipts (reported in ? ) from providing food
service under contract to the following facilities
(Report all government hospitals, nursing homes, schools, etc. on line g.)

Whole percent
of sales and
receipts

a. Hospitals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2351

b. Nursing homes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2352

c. Commercial offices and office buildings . . . . . . . . . . . . . . . . . . . . . . . . .

2353

d. Manufacturing and other industrial plants . . . . . . . . . . . . . . . . . . . . . . . .

2354

e. Colleges or universities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2355

f. Primary and secondary schools . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2356

g. Governmental organizations (Federal, state, local), including correctional facilities . . . . .

2357

h. Airlines, ships, railroads, buslines, and other in-transit facilities . . . . . . . . . . . . . .

2358

i. Stadiums, clubs, and other recreation and amusement facilities . . . . . . . . . . . . . .

2359

%
%
%
%
%
%
%
%
%

j. Other - Specify
0896

k. TOTAL (Sum of lines 2a through 2j should equal percentage reported on line 1) . . . . . .

2360

2361

%
%

AF-72202
#L

FRANCHISE
1. Was this establishment operating under a trademark(s) authorized by a franchisor in 2012?
(Mark "X" only ONE box.)
0237

Yes - franchisee-owned establishment

0238

Yes - franchisor-owned establishment

0239

No

2. If yes, provide the trademark(s) below.

0236