ServSafe Request Form Home 5 ServSafe Request Form ServSafe Request Form EmailThis field is for validation purposes and should be left unchanged.Name(Required) First Last Email(Required) Phone Number(Required)Company(Required)My affiliation with Y. Hata(Required) I am a current customer of Y. Hata. I am an account manager at Y. Hata. I am not affiliated with Y. Hata. Account Manager at Y. Hata(Required)Please type NA if you do not have an account managerDo you have a laptop?(Required) Yes I have a laptop and I will bring it with me to the class. No, I will need to borrow a lap top. $175 ServSafe Manager Course Payment must be submitted by check or card only.(Required) By Checking this box I confirm that I understand the cost of the ServSafe class is $175 check or card and that no cash will be accepted.ServSafe Date of Interest(Required) January 18, 2027 February 15, 2027 March 15, 2027 April 19, 2027 May 17, 2027 June 21, 2027 July 19, 2027 September 20, 2027 October 18, 2027 Comments or questionsPlease let us know if you have any questions or comments.
