Agent Form

    Date:

    POS Bundle

    POS Type:

    Quantity:

    Blank Database Required:

    Credit Card Pinpad:

    Quantity:

    Stand:

    *not applicable for D210

    Scanner:

    Quantity:

    Additional Scanner:

    Quantity:

    Cash Drawer:

    Quantity:

    Receipt Printer:

    Quantity:

    Keyboard/Mouse:

    Quantity:

    Label Printer:

    Quantity:

    Back Office Software:

    *For additional Back Office Software licenses, there will be additional cost

    Third Party Vendors

    Scan Data:

    Loyalty:

    Data Transfer from Old POS

    Data Transfer:

    *If Yes, please fill the Data Transfer Form

    With Existing Hardware

    PtechPOS Software:

    Note: We are not responsible for any unresponsive merchandise