Request for Quotation



         First Name                                           Last Name
            

         Business Name
         
         Street Address
         
         City
         
         State                Zip Code
              

         Telephone
         

         Fax
         

         Email Address
         

         Company Web site
         

         Description of Business
         

         No. of Stores              Total POS Lanes
          1 2-4 5-10 11-50 More than 50      1 2-5 6-20 21-50 More than 50

         When are you planning to implement a new POS system?
          Immediately Up to One Month Up to Six Months Up to a Year More than a Year

         What input device(s) will be connected to your POS system?
         (Check all that apply)
         Standard Keyboards
         Magnetic-Stripe Reader Keyboards
         Barcode Scanners
         Touch Screen Displays
         Pole Displays
         Scales
         Wireless Devices
         Other (please specify)    

         Current Debit/Credit Card Processor
         

         How did you hear about us?
         Referred by Microsoft Referred by Dell Referred by another client Found on Microsoft's web site Found on search engine web site Found on other web site Received literature Received sales call Other