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C Mart Technologies Equipment Set Up Form
Sales Representative Name *
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COMPANY INFO
Merchant's DBA Name *
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Merchant's DBA Address *
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Merchant's Phone # *
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TERMINAL TYPE
Vx520 Dual Comm Qty
Your answer
Vx680 Wireless Qty
Your answer
Ingenico ICT220 Qty
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FD130 Qty
Your answer
Phone Swipe / Audio Jack Qty
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Tablet Qty
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PIN Pad Type (Check boxes)
PIN Pad *
Required
Internal PIN Pad
VeriFone PP1000SE Qty
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VeriFone Vx805 Sig Cap Qty
Your answer
VeriFone Other
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Ingenico IPP310 Qty
Your answer
Ingenico IPP320 (Semi Integration Only) Qty
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FD130 PIN Pad Qty
Your answer
SOFTWARE
Software Name
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Software Version Number
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Vendor Name
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Vendor Phone #
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Connection Type
Printer and/or Check Image notated directly on doc
Terminal Download Instructions
ISP Name (if IP Connection Above)
Your answer
Special Requests/Comments
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