Request for a Personalized e-Commerce Shopping Site | Bank Equipment Parts and Supplies | Reseller for HP, IBM, X-stamper, Kentek, Tally, NCR, BancTec

Request for a Personalized e-Commerce Shopping Site

Earn rewards using our e-commerce ordering system. Turn your On-Line ordering visits into value packed rewards in 2010!

You can establish a personalized e-commerce account one of four ways. These are as follows:

Fill out this form completely than fax to: (207) 848-7300
Fill out this form on line.
Fill out this form over the phone with the assistance of a customer service representative: (800) 675-7669
Fill out this form completely than mail to:
Eagle Direct
1 Printer's Drive
Hermon, Maine 04401

CUSTOMER CONTACT & PASSWORD REGISTRATION INFORMATION
First Name
Last Name
Company/Credit Union/Bank Name
Title
Street (No PO Box address)
Suite
City
State
Postal Code
Telephone (Include Area Code)	Ext
Fax (Include Area Code)
Country Code (If Outside US)
E-Mail
Requested User Name
Requested Password
Number of Branches
Do you want each branch to have access to the system?
Would you like a central purchasing administrator to approve all branch orders?
Comments:
How Did You Hear of Us?

Please fill in or check the products below that you would like included in your
Personalized e-Commerce Shopping Site. Please check all that apply.

TELLER SUPPLIES

ATM SUPPLIES

CREDIT CARD SUPPLIES

	Cleaning Kits		Hypercom
	Verifone		Other

CHECK PROCESSING SUPPLIES

	Check Repair Strips		Check Trays & Carts
	Document Carriers		Batch Tickets
	Check Storage Cartons		Clear Transit Bags
	Single or Double Pocket Jogger		Check Correction Supplies
	Cleaning Supplies		IRD Documents
	MICR Toner Supplies		Stock Check Image Paper

CHECK READER, SORTER & PROOF SUPPLIES