Contact Us

Kiosk Prepaid Initial Inquiry Form

1. Company Name (DBA if any): *This question is required.

2. Company Contact Person: *This question is required.

3. Contact Number: *This question is required.

4. Email Address: *This question is required.

5. Address: *This question is required.

6. City and State *This question is required.

7. Website:

8. Please provide a general description of Location Type(s): (IE: Convenience Store, Grocery Store, Shopping Center, etc) *This question is required.

9. How many locations do you represent or plan to represent? *This question is required.

10. What is the average number of customers you see on a daily basis *This question is required.

11. Please choose the option that applies: *This question is required.

12. When are you looking to begin?

14. Best Contact time:

15. Additional Comments: