Terminal Needs

Terminal 1 :

How many :

Rent Free / Buy:

Terminal 2 :

How many :

Rent Free / Buy:

Terminal 3 :

How many :

Rent Free / Buy:


Company Information

Company legal name :

Company operating as name :

Company Full Address:

City :

Province:

PostalCode :


Company phone:

Company fax:

Company email:


Company web site:

Description of products and services sold:

Company GST/HST tax number:

When started the business:

Projected $ monthly volumes:

Average $ sale (ticket size):

Void Cheque (in jpg/png/PDF format)

Owner Information

Owner first name:

Owner last name:

Owner Full Address:

City :

Province:

PostalCode :


Owner home or cell phone number:

Owner date of birth :

Percent of company ownership (%):

SIN number:

Promo Code:


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