Thursday, July 24, 2008

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ISO&Agent YES! Please start my FREE subscription to ISO&Agent. To order please call (800) 221-1809 or (212) 803-8333 or complete the form below and click the submit button. * Indicates required field * First Name: * Last Name: Title: * Company: Address: City: State: AK AL AR AS AZ CA CO CT DC DE FL FM GA GU HI IA ID IL IN KS KY LA MA MD ME MH MI MN MO MS MT NC ND NE NH NJ NM NV NY MP OH OK OR PA PR RI SC SD TN TX UT VA VI VT WA WI WV WY Zip/Postal Code: Phone: Fax: * Email Address: * Confirm Email Address: By providing my fax number and/or email address, I consent to receive communications sent by or on behalf of SourceMedia™ via fax or email. Customer information will be used in accordance with SourceMedia’s privacy commitment. * 1. Do you currently sell POS Terminals? yes        no * 2. Do you currently sell ATMs? yes        no * 3. Do you sell or plan to sell wireless internet access? yes        no * 4. What brands of POS terminals do you sell? (Check all that apply) A.  Hypercom B.  Verifone C.  Ingenico D.  Lipman E. Other (please specifiy)  * 5. What brands of ATMs do you sell? (Check all that apply) A.  Diebold B.  NCR C.  Triton D.  Tidel E.  Wincor-Nixdorf F.  Fujitsu G. Other (please specifiy)  * 6. Are you looking to expand your product line? yes        no * 7. What markets do you sell to? (Check all that apply) A.  Retail       B.  Restaurants C.  QSRs D.  Hospitality E.  Grocery F.  Banking/Financial Services G.  Education H.  Transportation I.  Entertainment * 8. On average how many POS terminals or ATMs do you sell per month? Please select an answer 1-5 6-10 11-20 21-30 31-40 41-50 51-100 100+

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