Requisition Supplies/Materials Form

Date*

Date

Dealer Company Name*

Requesters Name*

First NameLast Name

Terms of Payment*

Use credit card on fileWill call for new payment methodOptima Rewards (if selected please answer below)

How many Optima Rewards points would you like to use towards your purchase?

*To check your points balance, log into the Dealer Portal. Your points total will be displayed at the top, next to your name. If you have any questions, please don't hesitate to contact us.

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APOS Series

	Quantity Requested
1. APOS-01: 6” Portable Touch Screen System
2. APOS-02: 8” Touch Screen System
3. APOS-03: 8” Touch Screen System
4. APOS-04: 10” Touch Screen System
5. APOS-05L: 12” Touch Screen System
6. APOS-05: 15.6” Touch Screen System

WPOS-Series

	Quantity Requested
1. WPOS-05: 15.6" Windows Based POS Terminal

Scales

	Quantity Requested
1. OPT-OSGX-30: POS Interface Scale

Receipt and Kitchen Printers

	Quantity Requested
1. OPT-P100: Thermal Receipt Printer 3 1/8” (80mm)
2. P200 Thermal Printer (2 1/4” paper size)
3. OPT-P250: Thermal Receipt Printer 2 ¼” (58mm)
4. OPT-150KP: Thermal Kitchen Printer 3 1/8” (80mm)
5. OPT-P300-BR: Dot Matrix Kitchen Printer 80mm (3 1/8")

Pole Display

	Quantity Requested
1. APOS-E2PD: External 2-Line USB Pole Display
2. OPT-EPD7: APOS 7” remote pole display
3. OPT-EPD10: APOS 10” remote pole display

Cash Drawers

	Quantity Requested
1. OPT-4141: 4 or 5 Adjustable Bill Holder ,410(W) x 420(D) x 100(H)mm

Barcode Scanners

	Quantity Requested
1. OPT-5000: 2D & 1D Omni Ddesktop Barcode Scanner
5. OPT-3500-AT: 1D/2D Wireless Hand held Barcode Scanner with Bluetooth
6. MS7120: Honeywell’s Orbit 7120 Omnidirectional Scanner
7. MS9540: Honeywell's VoyagerCG™ 9540 handheld

Stands

	Quantity Requested
1. OPT-04S: Utility Stand for APOS-04

Important notes

Optima Purchase Order Form

Products List

POS Systems

Accessories