New Client Registration Form (Shift4)
Please fill out all fields. If there are questions, please call 877-662-5729, x 13.
Requested Install Date
*
-
Month
-
Day
Year
Date
Customer Details:
Company/Business Legal Name
*
EIN
*
Legal Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Legal Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Company/Business DBA Name
*
DBA Address is Same as Legal?
*
Yes
No
DBA Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Business Email
*
example@example.com
DBA Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Website (if applicable)
*
OWNERSHIP
Ownership
Any owner of 25% must be listed.
Owner 1 Full Name
*
First Name
Last Name
Owner 1 Phone Number
*
Format: (000) 000-0000.
Owner 1 E-mail
*
example@example.com
Owner 1 SSN
*
Owner 1 DOB
*
-
Month
-
Day
Year
Date
Owner 1 % Ownership
*
Owner 1 Title
*
Owner 2 Full Name
*
First Name
Last Name
Owner 2 Phone Number
*
Format: (000) 000-0000.
Owner 2 E-mail
*
example@example.com
Owner 2 SSN
*
Owner 2 DOB
*
-
Month
-
Day
Year
Date
Owner 2 % Ownership
*
Owner 2 Title
*
Owner 3 Full Name
*
First Name
Last Name
Owner 3 Phone Number
*
Format: (000) 000-0000.
Owner 3 E-mail
*
example@example.com
Owner 3 SSN
*
Owner 3 DOB
*
-
Month
-
Day
Year
Date
Owner 3 % Ownership
*
Owner 3 Title
*
BUSINESS DETAILS
Largest Ticket
*
Average Ticket
*
Please attach Voided Check
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Gift Cards?
*
Yes
No
Maybe
For existing gift card programs, please attach liability report
Browse Files
Drag and drop files here
Choose a file
Cancel
of
ORDER DETAILS
Enter the total number of units needed in text field below hardware:
*
Rows
SkyTab SOLO
SkyTab POS Bundle
SkyTab Mobile
SkyTab Air
SkyTab Glass
Customer Display
16" KDS
22" KDS
Scanner
Thermal Printer
Dot Matrix Printer
Label Printer
2 Line Caller ID
4 Line Caller ID
Digital Scale
Total Units
CONTRACT TERM
Defaults to Shortest Term
*
36 Months
60 Months
Submit
Should be Empty: