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Reference Code (if you have one)
Merchant Contact Info  
Administrative Contact Name
Company Name
City, State (province), ZIP
Phone No. (+ Area Code & Extension)
Fax No. (+ Area Code)
Email Address
http/web-site address (if any)
Business Info  
I currently accept credit cards (check all that apply) Visa/MC Amex Discover Diners Gusto
I would like to accept credit cards on the web portal (check all that apply) Visa/MC Amex Discover Diners Gusto
I would like the ability to  accept checks on-line
I would allow   non-secured cash transactions on-line
I would like to  have the portal linked-through from my web-site
I do not have a web-site  and would like to be placed within the eat2go network directory
I would like a web-site  developed for me
I have a dial-up ISP provider  (connection to the Internet) via a dial-up modem
I have a broadband provider  (connection to the Internet) DSL, Dish, Cable, etc.
I have a POS system and network in my establishment, and would like to print to a remote printer, if my POS provider allows this
I would like a separate receipt printer wireless, or otherwise connected to my PC
I will print the arriving orders  on a standard printer connected to a PC
I would like to receive my orders by fax and I will administer (start/stop/make changes) to my portal from another location or by someone else
I do not have  any seating availability
I have  locations that I would like to connect to the eat2go portal.
My business classification is:
My average check is: 
We would like to  provide images of our product lines for the eat2go portal
We can  perform rudimentary data entry and/or we are somewhat familiar with Information Technology and/or we have a POS system currently running which is managed in-house
I would like  information regarding a POS system
We definitely need an affiliate to help us because we do not have enough time, and/or unfamiliar with this type of technology and/or we are sure someone that does this all the time will do it better.

Please send me more information regarding eat2go/initiate contact with me and/or consider me as someone that recognizes
the benefits of eat2go, the incremental sales and the exposure it generates and the future direction of the industry.

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Should you mistype it, you will be returned here for another try. Why is this here? Unfortunately, this had to be implemented in order to stop auto-submitters from automatically registering businesses from other domains and attempting to charge a premium.