Reprogram/Purchase Form

This form is for the reprogram or purchase of the Valor VL100, VL110, VL500 and the Dejavoo QD4 and QD2.
Merchant & Partner Information
A signature request will be sent to this email.
A confirmation email will be sent to this email.
Order Type:
Amount:
Device:
Download Parameters
Program:
Application Type:
Restaurant:
Debit Enabled:
PIN Pad:
QSR:
Features:
Touchscreen Signature Capture:
Primary Connection Method:
Backup Connection Method:
EBT:
Dual Pricing Configuration
%
% above cash price (1-5%)
Flat fee amount
Minimum amount to default to flat fee
Discount Frequency:
Ship To
Shipping Address
City/Town
State
Zip Code
Bill to:
All set!

Your submission has been received and our deployment team will get to work as soon as possible.

You should receive an email confirmation with an attached PDF of this form with the info you provided.
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