New Client Registration Form (Shift4)
Please fill out all fields. If there are questions, please call 877-662-5729, x 13.
Sales Agent
Casey
Cameron
Nate
To Be Assigned
Requested Install Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit 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
2 digit month, 2 digit day, 4 digit 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
2 digit month, 2 digit day, 4 digit 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
2 digit month, 2 digit day, 4 digit 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
EBT?
*
Yes
No
EBT FNS Number
Issued by your state.
Cash Discount?
*
Yes - 4%
No
Maybe - Please Contact Me to Discuss.
Tax Rate
Enter Tax Name and Percentage, separated by comma for multiple tax rates. If inclusive, please note.
Batch Close Time
Please include the time of day and time zone.
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: