ServSafe Request Form Home 5 ServSafe Request Form ServSafe Request Form 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 conform 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 19, 2026 February 23, 2026 March 16, 2026 April 20, 2026 May 18, 2026 June 22, 2026 July 20, 2026 August 24, 2026 September 21, 2026 October 19, 2026 Comments or questionsPlease let us know if you have any questions or comments.
