Date: Agent Name: Store Name: Store Email: Store Phone: Shipping Address (if different from store address): POS Bundle POS Type: Dual ScreenSingle Screen Quantity: 12345678910 Blank Database Required: C-StoreLiquor StoreSupermarketTobacco StoreBlank Database w/o Items Credit Card Pinpad: S300D210PX5 Quantity: 12345678910 Stand: YesNo *not applicable for D210 Scanner: YesNo Quantity: 12345678910 Additional Scanner: NoneWirelessBluetooth Quantity: 12345678910 Cash Drawer: YesNo Quantity: 12345678910 Receipt Printer: YesNo Quantity: 12345678910 Keyboard/Mouse: YesNo Quantity: 12345678910 Label Printer: YesNo Quantity: 12345678910 Back Office Software: Included with BundleAdditional Charges Applied *For additional Back Office Software licenses, there will be additional cost Third Party Vendors Scan Data: YesNo Loyalty: YesNo Data Transfer from Old POS Data Transfer: YesNo *If Yes, please fill the Data Transfer Form With Existing Hardware PtechPOS Software: YesNo Note: We are not responsible for any unresponsive merchandise Submit