1. Restaurant Information
Restaurant Name *
Address 1 * Restaurant Web Page
City * State / Province *
Zip Code * Restaurant Phone *
2. Contact & Billing Information
Business Entity * Serial # of Restaurant *
Person Completing This Form * Contact Cell Phone *
The business agrees to provide both credit card and bank routing information for the payment of RM Loyalty Service Fees, selecting the payment method below as the primary method of payment and relying on alternative payment methods only in the case that the primary method of payment fails:
Yes   No
Primary Method of Payment:
Company Credit Card   Bank Transfer (ACH)
(Fees are not applied to Shift4 RM Payment accounts)
3. Service & Support
POS Service Provider *
Restaurant is currently enrolled in an Annual Service Plan with service provider above:
Yes   No
Expiration Date on this Service Plan
We understand there is a messaging fee of 4c per message:
Yes   No
(Initial 500 SMS points provided free per restaurant with account)
4. RM Loyalty Service Agreement

I decline
I have read the RM Loyalty Service Agreement and accept the terms of this Agreement on behalf of the Business Entity above.
WARNING: If you choose not to accept the terms of the RM Loyalty Service Agreement, Restaurant Manager will not be able to process this RM Loyalty Confirmation.