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Office Info:
Store Info:
Name:
Store #:
Region:
Please Select
Atlanta
Baltimore-Washington
Baltimore-Washington BWR
Boston
Chicago
Florida
Great Southern Region
Greater Southwest Region
Hawaii
Heartland Region
Houston Region
Indianapolis
Michigan
Midwest
NY Metro Region
Northwest
Ohio
Pacific Sierra
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Pittsburgh
Raleigh Region
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Southern California
Unknown Region
Store Region:
Please Select
Atlanta
Baltimore-Washington
Baltimore-Washington BWR
Boston
Chicago
Florida
Great Southern Region
Greater Southwest Region
Hawaii
Heartland Region
Houston Region
Indianapolis
Michigan
Midwest
NY Metro Region
Northwest
Ohio
Pacific Sierra
Philadelphia
Pittsburgh
Raleigh Region
Rocky Mountain
Southern California
Unknown Region
Address:
Store Address:
City:
City:
State:
Please Select
ALABAMA (AL)
ARKANSAS (AR)
ARIZONA (AZ)
CALIFORNIA (CA)
COLORADO (CO)
CONNECTICUT (CT)
DISTRICT OF COLUMBIA (DC)
DELAWARE (DE)
FLORIDA (FL)
GEORGIA (GA)
IOWA (IA)
IDAHO (ID)
ILLINOIS (IL)
INDIANA (IN)
KANSAS (KS)
KENTUCKY (KY)
LOUISIANA (LA)
MASSACHUSETTS (MA)
MARYLAND (MD)
MAINE (ME)
MICHIGAN (MI)
MINNESOTA (MN)
MISSOURI (MO)
MISSISSIPPI (MS)
MONTANA (MT)
NORTH CAROLINA (NC)
NORTH DAKOTA (ND)
NEBRASKA (NE)
NEW HAMPSHIRE (NH)
NEW JERSEY (NJ)
NEW MEXICO (NM)
NEVADA (NV)
NEW YORK (NY)
OHIO (OH)
OKLAHOMA (OK)
OREGON (OR)
PENNSYLVANIA (PA)
RHODE ISLAND (RI)
SOUTH CAROLINA (SC)
SOUTH DAKOTA (SD)
TENNESSEE (TN)
TEXAS (TX)
UTAH (UT)
VIRGINIA (VA)
VERMONT (VT)
WASHINGTON (WA)
WISCONSIN (WI)
WEST VIRGINIA (WV)
WYOMING (WY)
State:
Please Select
ALABAMA (AL)
ARKANSAS (AR)
ARIZONA (AZ)
CALIFORNIA (CA)
COLORADO (CO)
CONNECTICUT (CT)
DISTRICT OF COLUMBIA (DC)
DELAWARE (DE)
FLORIDA (FL)
GEORGIA (GA)
IOWA (IA)
IDAHO (ID)
ILLINOIS (IL)
INDIANA (IN)
KANSAS (KS)
KENTUCKY (KY)
LOUISIANA (LA)
MASSACHUSETTS (MA)
MARYLAND (MD)
MAINE (ME)
MICHIGAN (MI)
MINNESOTA (MN)
MISSOURI (MO)
MISSISSIPPI (MS)
MONTANA (MT)
NORTH CAROLINA (NC)
NORTH DAKOTA (ND)
NEBRASKA (NE)
NEW HAMPSHIRE (NH)
NEW JERSEY (NJ)
NEW MEXICO (NM)
NEVADA (NV)
NEW YORK (NY)
OHIO (OH)
OKLAHOMA (OK)
OREGON (OR)
PENNSYLVANIA (PA)
RHODE ISLAND (RI)
SOUTH CAROLINA (SC)
SOUTH DAKOTA (SD)
TENNESSEE (TN)
TEXAS (TX)
UTAH (UT)
VIRGINIA (VA)
VERMONT (VT)
WASHINGTON (WA)
WISCONSIN (WI)
WEST VIRGINIA (WV)
WYOMING (WY)
Zip:
Zip:
Telephone:
Manager:
Cell Phone:
Installation Date:
Fax:
Store Phone #:
Email:
Store Fax #:
Current System:
None
MAPS
PAN PC/POS
PAN II
PAR PC/POS
PAR II
Javalen
Olivetti
IBM
Other
Re-use Existing?
(Click for Yes)
(Click for Yes)
CCU?
Printers?
Verifone?
WRIN?
Cash Drawers?
Monitors?
Registers?
List the model numbers of any equipment to be re-used in the Comments section below.
Equipment:
FC Registers:
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
Cash tendered at presenter's booth?:
Yes
No
DT Registers:
0
1
2
3
4
Extra Grill Printer:
Yes
No
Number of DT COD's:
0
1
2
ABS:
None
Re-use
New
CBB Installed?:
Not Selected
Yes
No
Quote Me
DT Lanes:
None
Single
Tandem
Dual
Flipped ABS:
Not Selected
Yes
No
Comments:
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2018
Sales Data, Inc - Mid-America Point of Sale - All rights reserved
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