Survey Date:
Company Name:
Estimate Installation Date:
PetrotechPOS
Verifone Ruby CI Commander
Verifone Ruby Topaz Commander
Gilbarco Passport
Other
*To find out the version of the commander: 1 - Go to CSR Menu (bottom right corner) 2 - Select option 5 3 - Login with the manager ID and Password 4 - Click "Help" & then "About", the version will be shown under Configuration
Wayne Fusion
Verifone Commander
FD Buypass
Heartland
Debit Encryption Key:
Wayne
Gilbarco
Tokheim
Bennett
—Please choose an option—Vista IIVista IIIovation-Iovation-II-HelixHarmony
—Please choose an option—Encore 300Encore 500Encore 500s/700sAdvantage
—Please choose an option—Premier BPremier C262A
How Many Dispensers (MPD):
—Please choose an option—123456789101112
How Many Pumps/Fueling Positions:
—Please choose an option—123456789101112131415161718192021222324
Number of Tanks:
—Please choose an option—1234567891011121314151617181920
Grades:
Tank Size:
Please provide dispenser pictures: one of the Outside of dispenser door (include card reader) and one of the Inside of dispenser door
Full Pump Picture: (Taken From Aleast 10 Feet Away )
Inside Of Dispenser Door:
Outside Of Dispenser Door:
Types Of POS(Ruby etc):
Fuel Controller Box:
Fuel Setup Area(D-Box,G-Box etc):
Internet Setup(Cyberia, MAACO etc): (Optional)
Georgia (HQ)
Chicago
