Order Form

Date

Merchant Information

Name

Address

Phone

Email

Shipping Address

Same as Merchant Info

Name

Address

Phone

Email

Store Name

Store Address

Agent Name

Bundle

Quantiy

Type of Database

Scanner

Quantiy

Cash Drawer

Quantiy

Dual Pricing

Percentage(%)

Add-ons (not inculded in the bundle)

Credit Card Terminal

Quantiy

Credit Card Terminal Stand

Label Printer

Quantiy

Label Roll

Quantiy

Battery Backup

Quantiy

5 Port Switch

Quantiy

Notes