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Office Info: Store Info:
Name:Store #:
Region:Store Region:
Address:Store Address:
City:City:
State:State:
Zip:Zip:
Telephone:Manager:
Cell Phone:Installation Date:
Fax:Store Phone #:
Email:  Store Fax #:

Current System:

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:Cash tendered at presenter's booth?:
DT Registers:Extra Grill Printer:
Number of DT COD's:ABS:
CBB Installed?:DT Lanes:
Flipped ABS:
Comments:




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P.O. Box 1688 | 15 North Adams | Hutchinson, KS | 67504-1688 | Voice 620-663-9193 | Fax 620-665-0793