RESTAURANT MANAGER ORDER FORM



Reseller Information

|Company Name:       |Order Placed By:       |

|Order Date:       |Key Contact on this project:       |

|E-mail of key contact:       |

Domain and Hosting Information

If you have a registered domain name you wish to use for this new website, please list it below:

|      |

If not, please provide three Domain Names you wish to have ASI try to try to register:

|1.       |2.       |3.       |

Please list up to 4 E-mail addresses for use at this URL (Ex: sales@, JSmith@, etc.):

|1.       |2.       |3.       |4.       |

|Please indicate the USERID you use to access ASI’s DealerServices website:       |

|Do you wish to use this same USERID as the suffix that identifies our custom version of the website? |

|Ex.: Acme Y / N |

|If NO, please provide an alternative ID:       |

Do you wish to have ASI host this website: Y / N

If YES, please detail the Credit Card to which we should charge the $20 monthly fee

|Credit Card: |Visa |MasterCard |AMEX |

|Card #:       |Exp. Date:       |Name on Card:       |

|Billing Address of Card:       |Security Code:       |

Website Content

Please read the copy on each page of the website template and then indicate below whether you wish to update the existing copy with details about your dealership or whether you prefer to submit custom copy of your own that ASI can post on your behalf:

Home Page

I will submit custom copy for this page to Design@

Please use the information below to insert details about my company into the basic copy on the standard reseller website template

Please call the reference below to get a quote you can use on our home page:

|Restaurant:       |Contact:       |

|Phone:       |Topic to discuss:       |

I will email a photo of this restaurant and contact to Design@

Info to update template copy:

|Year company founded:       |Market served:       |Technologies offered:       |

| Wireless Pay-at-the-Table | Security Cameras | Online Ordering |

| Website Design | Inventory Control | Gift Cards |

| Customer Loyalty & Email Clubs | Employee Scheduling | FACTA & PCI Compliance Training |

|Other:       |Other:       |Other:       |

|Sales phone number:       |

POS Products Page

I will submit custom copy for this page to Design@

Please use the standard copy on the reseller website template along with a link to the Home Page

Please include the Chat n Chew logo on this page so I can demo Online Ordering to my prospects. (I understand that there is a separate fee* to enable the Online Ordering link on my website). *See the Web Service Demo Form

Other Products Page

I will submit custom copy for this page to Design@

Please use the copy below on the Other Products page of our website along with the product offerings indicated.

I wish this page to display logos of equipment manufacturers not listed below and will email JPG versions of these logos to Design@

Info to update template copy:

| not only sells and installs POS Systems, we’re a one-stop shop for all the technologies restaurants need to succeed, including: |

| Wireless Pay-at-the-Table | Security Cameras | Online Ordering |

| Website Design | Inventory Control | Gift Cards |

| Customer Loyalty & Email Clubs | Employee Scheduling | FACTA & PCI Compliance Training |

|Other:       |Other:       |Other:       |

A note about equipment:

When it comes to hardware recognizes that the foodservice industry requires rugged, top quality equipment and we offer our clients only those makes and models that we have evaluated according to foodservice standards. All hardware provided to the client is always tested and “burned in” by ACME POS before it is delivered to the client’s establishment. Some of the brand name equipment we offer includes:

| Epson | Posiflex | CRS | Touch Dynamics |

| PartnerTech | Verifone | Scannabar | Socket |

| Motorola | TelCom | MS Cash Drawer | |

Service & Support Page

I will submit custom copy for this page to Design@

Please use the information below to insert details about my company into the basic copy on the standard reseller website template

Info to update template copy:

|# of months of free support offered on new systems:       |Daytime support phone:       |

|After hours support phone:       | |

Testimonials Page

I will submit custom copy for this page to Design@

Please use general ASI user references on this page website

Please call the references below to get testimonial quotes that can be posted on this page along with a link to their website:

Restaurant 1

|Restaurant:       |Contact:       |

|Phone:       |Website:       |

Restaurant 2

|Restaurant:       |Contact:       |

|Phone:       |Website:       |

Restaurant 3

|Restaurant:       |Contact:       |

|Phone:       |Website:       |

Contact Us Page

I will submit custom copy for this page to Design@

Please use the standard template for this page that lists our main company address

All data collected via the Info Request form on should be emailed to our dealership at the following address:      

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