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MDF Network
P.O. Box 213013
West Palm Beach , FL , 33421

BMI POS
3845 Investment Lane S-3
West Palm Beach , FL , 33404

Cash Register Services
214 South H St.
Lake Worth , Fl , 33460

US Merchant Services
451 SW Bethany Dr. Ste#201
Port St. Lucie , FL , 34986

First & Last Name:

Business Name:

Email:

Phone Number:

Address:

City:

State:

Zipcode:

1. In what type of business will the POS system be used?
Bar Night Club
Hospitality (Hotel, resort, spa etc...)
Restaurant: Quickserve (Fastfood, cafe, coffee shop and delivery)
Restaurant: Full Service
Restaurant: Fine Dinning
Restaurant: Delivery
Restaurant: Pizzeria, Ristorante
Frozen Yogurt Shop
Food Truck
2. Timeframe for this point of sale Purchase?
Asap
0-3 Months
4-6 Months
6 months or longer
Not Sure
3. What additional device(s) will your POS system utilize?
Guest Pagers
Server Pagers
Integrated POS Cameras
Wireless POS
4. Please indicate how many of the following POS Components you will need for each of your locations?
Number of Pos Terminals

Remote Printers (Kitchen printer or bar orders etc...)
5. Please describe in detail any other requirements you may have for you POS system.

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