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Information Request Form
To handle your request better, we need information about you and your business.
Please supply us with the following information
 indicates required fields.
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| First Name : |
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| Middle Name : |
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| Last Name : |
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| Business Trade Name : |
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Business Legal Name :
if different than trade name |
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Type of Business
(Please describe about your business) |
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| Number of locations : |
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Street Address :
(including building or suite number) |
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| City : |
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| State : |
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| Zip : |
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| Country : |
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| Telephone : |
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| Fax : |
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| Email Address : |
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| Web Site Address : |
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Which products or solutions are you interested in?
(Select one or more products) |
Retail POS System
Restaurant POS System
Accounting/Financial System
Bar Coding System
E-Commerce/Web Development Solutions
Software Customization/Development
Other
if other,
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Request Information
(Select one or more requests) |
Send me a brochure or demo cd.
A cagalog for all product line
Have someone call me
Would like to see a sales rep
Other
if other,
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| Comments : |
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We would like to send you updated product information or promotional information through email or fax. Please indicate below if you don't want this service.
Yes, I want it.
No, I don't want it.
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:: Read Privacy Policy
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