Transact Campus PayKiosk Sales Intake Form

Note this is a referral document. The Transact sales team gathers the

information from the customer, and completes this form.

1. Name of School/University/Institution

2. School Main Point of Contact Name, Telephone Number, & Email Address

First Name of Main Contact

Last Name of Main Contact

Phone of Main Contact

Email of Main Contact

3. School Main IT Contact Name, Telephone Number, & Email Address

First Name of IT Contact

Last Name of IT Contact

Phone of IT Contact

Email of IT Contact

4. Transact Account Manager Name, Telephone Number, & Email Address

First Name of Account Manager

Last Name of Account Manager

Phone of Account Manager

Email of Account Manager

5. Number of Campus PayKiosks they wish to order

6. Kiosk Functionality Needs

Cash Only

Cash and Credit

Credit Only

7. What TSE version is in use currently? (Must be 4.X or higher)

8. What is the desired delivery date from the customer (We will do our best to hit these dates, it is not a guarantee they will arrive by then) Standard lead time is 6-8 weeks.

9. Please provide details of where the Campus PayKiosks will be located? Will they be located inside or outside? Are they replacing an existing machine? Are Power and Ethernet access available at the locations? Any other details that may assist.

A note on the customization process: After receipt of order, Self-Service Networks will take the colors and the logo and mockup a kiosk virtually that shows how it will look with the school’s customization. There are points on the kiosk that can easily be customized with colors. Outside of what is mocked up, no other customization can be done to the kiosks.

Thank you for submitting!