PLEASE NAME YOUR SALES AGENT
*
LOCATION INFORMATION
BUSINESS LEGAL NAME
*
DBA NAME
*
DBA PHONE
*
DBA ADDRESS
*
CITY
*
STATE
*
ZIP CODE
*
CONTACT NAME
*
SSN OF PERSON OPENING THE ACCOUNT
*
PHONE
*
PORTAL LOGIN EMAIL ADDRESS
*
Name
ENABLE TIPS?
*
YES
NO
AUTO CLOSE TIME
*
Please Select
5 PM
6 PM
7 PM
8 PM
9 PM
10 PM
11 PM
(IF YOU HAVE MULTIPLE CLOSING TIMES, SELECT THE LATEST OPTION)
SURCHARGE TO CUSTOMER
*
SELECT QTY TERMINAL WIFI & CELLULAR
*
Please Select
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
$350.00 PER TERMINAL
SELECT QTY TERMINAL CELLULAR SIM CARD AND ACTIVATION
*
Please Select
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
$50.00 PER SIM CARD & ACTIVATION & $15.00 PER MONTH
SELECT QTY TERMINAL MOBILE DOCKING STATIONS WITH CHARGING
Please Select
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
$30.00 PER MOBILE DOCKING STATION
PLEASE INCLUDE A VOIDED CHECK OR A BANK LETTER
*
Browse Files
Cancel
of
PLEASE INCLUDE A COMPLETED AND SIGNED W9
*
Browse Files
Cancel
of
PLEASE INCLUDE ARTICLES OF INCORPORATION
*
Browse Files
Cancel
of
PLEASE UPLOAD DL OR ID
*
Browse Files
Person who uploads DL must be on Articles.
Cancel
of
PLEASE INCLUDE CERTIFICATE OF GOOD STANDING
*
Browse Files
Cancel
of
TITLE OF PERSON OPENING THE ACCOUNT
Please Select
CEO
CFO
OTHER
SHIPPING ADDRESS
*
Street Address
SHIPPING CITY
*
STATE
*
ZIP CODE
*
CONTACT NAME FOR SHIPPING
*
PHONE NUMBER
*
SHIPPING SPEED
*
2 DAY
OVERNIGHT
SPECIAL INSTRUCTIONS
Submit
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