Triple Play I.T.
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Installation Request
Business Name
Street Address
City
State/Region
Postal Code
Business Phone Number
Business Owners Name
Business Owner's Cell Phone Number
ISO/ISV/MSP Company Name
ISO/ISV/MSP Contact Name
ISO/ISV/MSP Contact Phone Number
ISO/ISV/MSP Contact Email
Point of Sale System
Please Select
Acadia POS
Aldelo POS
AuPhan POS
Bluu
Clover Systems
FranPOS
GO Tab
Paradise POS
Phase 3 POS
Quantic POS
Retail Cloud
Revel Systems
Spot On
Torch POS
Touch Bistro
Number of Stations
Please Select
1
2
3
4
5+
Number of Mobile Stations
Please Select
None
1
2
3
4
5-9
10+
Card Readers
Please Select
Integrated with Station
1
2
3
4
5+
Receipt Printers
Please Select
Integrated with Station
1
2
3
4
5+
Kitchen Printers or Kitchen Displays
Please Select
None
1
2
3
4
5+
Bar Code Readers
Please Select
Integrated with Stations
1
2
3
4
5+
Cash Drawers
Please Select
1
2
3
4
5+
Scales
Please Select
None
1
2
3
4
5+
Low Voltage Cable Runs
Please Select
None
1
2
3
4
5
6+
Network Switches
Please Select
None
1
2
3+
Router/Firewall
Please Select
Yes
No
Access Points
Please Select
None
1
2
3
4
5+
Battery Back Ups
Please Select
None
1
2
3
4
5+
Party Responsible for Billing
Please Select
ISO
ISV
MSP
Agent
Business Owner
Point of Contact Name Responsible for Billing
Point of Contact Email Responsible for Billing
Point of Contact Phone Responsible for Billing
Installation Date 1
Installation Date 2
Installation Date 3
Installation Notes
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