Need help? Email Jerry Pilcher at pilcher@rmpos.com

Licensee
1. Contact Info
Restaurant Name * Dealer Name *
Restaurant Contact Person * Restaurant Contact Email *
Phone * Cell Phone *
Address * City *
State / Province * Country
Zip * Fax # at Restaurant
System Maintenance
 My Restaurant Manager POS System is currently covered by a Maintenance Contract that is due to expire on:
 My Restaurant Manager POS System is NOT currently covered by a Maintenance Contract.
Email Marketing
 Yes, I currently DO email marketing
If yes, what company do you use for email marketing? (Fishbowl, Mailchimp, Constant Contact, etc.):
 No, I DO NOT DO email marketing
2. Facebook Info (If you do not have facebook, leave this section blank.)
Facebook URL Facebook Contact Name
Facebook Contact Phone Facebook Contact Email
3. Website Info (If you do not yes have a website, leave this section blank.  A Website is required)
Restaurant Website URL Webmaster Name
Webmaster Phone Webmaster Email
4. Restaurant - Customer Section
Types of Online Orders You Will Accept:
Check applicable Immediate Later Today Future Date
Pickup
Delivery
Delivery Charge Applicable? Minimum Order Amount($) for Delivery?
 I will use zip codes to limit the delivery area (enter them below)  OR   I will use Google Maps for Online Ordering Delivery area
Times / Days Accepting Online Orders
Day Pickup Open Pickup Close Delivery Open Delivery Close Notes
Mon
Tue
Wed
Thu
Fri
Sat
Sun
A flat percentage discount for the entire order is an option and helps promote use of
your new online site. What % would you like to discount (if any)?
Minimum order to qualify for discounts:
Would you like to offer a "one time only" percentage discount for new registered users?
(encourages customers to register)
Yes     No
If yes, what percentage?
In addition to the order being printed at the appropriate kitchen printer,
would you like a duplicate of the online order sent to a restaurant email account?
Yes     No
Duplicate of order that is sent to POS emailed to:
Email address to receive ORDER-FAILURE notification
Cell number to receive ORDER-FAILURE TXT notification
Carrier to use for ORDER-FAILURE TXT notification
5. Payment Options
Please mark the option that applies to your business:
 My restaurant will accept credit card payments online using the E-Commerce account below
that we have established for this purpose with RM Payments.
 My restaurant will accept credit card payments online using the E-Commerce account below
that we have established for this purpose with another payment processor.
My restaurant will offer an option to pay at the restaurant or pay at pickup.  Yes    No