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Business Name:
Street Address:
City:
State:
Zip Code:
Number of Years in Business:
Number of Business Locations:
Full Name of Business Owner:
Contact Number:
Email Address:
Preferred Language: EnglishSpanish / Español
Co-Owner Name:
Alternate Contact Number:
Monthly Revenue (approximate):
Type of Business (e.g., Retail, Restaurant, Salon, etc.):
Average Monthly Sales
Do you currently use a POS system? YesNo
If yes, what brand/system?
Are you interested in: POS as a ServiceFree POS SoftwareFree Card ProcessingLending
Average Monthly Card Sales (if any):
Preferred Installation Date / Urgency
When do you plan to install the new POS system? ASAPWithin 30 Days1–3 MonthsJust Exploring Options
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