Kiosk Hardware - NCR Kiosks and Wholesale Kiosk Systems

PHOENIX KIOSK QUOTATION REQUEST FORM

1. Display:

15" LCD, no touchscreen
15" LCD, touchscreen
17" LCD, no touchscreen
17" LCD, touchscreen

2. Printer:

No printer
Receipt printer
Full-page printer
Ticket printer

3. Keyboard:

No keyboard
With Keyboard

4. Options (check all that apply):

None
Magnetic Card Reader
Barcode Scanner
I.D. Badge-MSR Reader
Fingerprint Reader
WiFi

5. PC:

I will supply my own PC
I want the PC supplied by I&E

6. UPS:

No UPS; Power strip used instead
UPS

7. Enclosure Finish:

Black

Silver vein
Custom Color (subject to minimum order quantities)

8. Signage (check all that apply):

Vinyl Decals w/custom graphics

Light Box
2ND LCD Display

9. "Ala Carte" Service Options (check all that apply):

None
1) I&E installs and configures the software application
2) On-site hardware only installation
3) Break/fix field service
4) Custodial maintenance
5) Gold Disk image backup service

10. Application:

What is this kiosk going to do?:

(Please define your kiosk application)

What application software do you plan to use?:

11. 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

Preferred method of response:

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: