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Your Name
*
First Name
Last Name
Your Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
POS Partner Company Name
*
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Restaurant Details
Tell us about the restaurant these terminals will be installed in
Restaurant Name
*
Venue Type
*
Please Select
Fast / Casual
Quick Service
Full Service
Fine Dining
Bar / Pub
Nightclub
Other
Restaurant Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
New or Existing Restaurant?
*
Please Select
New
Existing
Replacing an Existing POS?
*
Please Select
No
Yes
Projected Live Date
*
-
Month
-
Day
Year
Date
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Hardware Details
Tell us about the hardware this merchant will be using
Number or Free ACT Terminals
*
Please Select
One
Two
Three
Would you like a matching number of Dejavoo P1 EMV terminals?
*
Yes
No
Is this merchant interested in handhelds?
*
Yes
No
Submit
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