Kiosk Hardware - NCR Kiosks and Wholesale Kiosk Systems

IBM PODIUM QUOTATION REQUEST FORM

1. Kiosk Head:

17" IBM Anyplace Kiosk

2. Options (Check all that apply):

Printer Tray
Keyboard Tray
Barcode scanner
Fingerprint reader
Card swipe
RFID reader

3. Application:

What is this Kiosk going to do?:

(Please define your application)

What application software do you plan to use?:

4. Requirements:

Quantity:

Date initial unit required:

Projected date of roll-out:

Is this project funded? Yes   No, not yet
Preferred Payment Options: Purchase   Lease    Rent

Other:
How did you hear about us?: Google   Yahoo    Referral

General Information:
Company
Name
Address
City	State/Province Zip/Postal Code
Country (if not U.S.)
Phone #	Fax #
E-mail

Kiosk Mirror Site Kiosk Main Server
Instruments & Equipment Company - 2 Wilson Drive - Unit 1 - Sparta - NJ - 07871

Phone: 973-579-0009 or 800-432-1255 - Fax: 973-579-6665 - email: iekiosk@iepos.com

General Information: