COO draft test page – Panasonic POS Client Portal

Change of Ownership EN WEB-SRM (1)

"*" indicates required fields

Any account changes to the POS require this form to be completed and submitted by the (new) owner.

All fields should be completed to ensure a smooth transition. Please fill out as much of the form as possible and if you are unsure or do not have the information needed, contact your regional manager for assistance. Keep in mind that we require three business days notice to pre-schedule a changeover.

Franchise*

Quebec*

This location is NOT in Québec

This location is in the province of Québec

Two steps must be completed for Panasonic Canada to perform a change of ownership in the province of Québec:

1. Collection of Revenu Québec information
2. Provision of location and ownership change details

This form cannot be submitted until these sections are complete.

1. Revenu Québec Account Information

The following information is required for configuration of MEV-WEB reporting. Additional details are available at the following link:

Configuring the Sales Recording System

1. The name under which you do business
2. The user’s first and last name, or name of your company
3. The billing file number for your business
4. The QST registration number of the business or establishment (e.g. 1234567890TQ0001)
5. The GST registration number of the business or establishment (e.g. 12345RT0001)
6. The authorization code (for example, X9X9-X9X9)
7. The name you wish to give to your digital certificate for revocation purposes in the event of equipment breakage or theft

This information is required for processing your change of ownership.

2. Location and Ownership Details

Please provide the following details regarding the location and change of ownership.

Beavertails

Restaurant ID*

Location (City)*

Requested changeover date*

The specific date that you will take ownership and begin operations.

Note: Panasonic requires a minimum of 3 business days notice to schedule and assist in your ownership change.

Once this form has been submitted you will receive a reply within 24 hours on the following business day with a reference number, along with further instructions if required.

Requested changeover time (HR + MM)*

Enter the requested time in 24 hour format in YOUR local time zone.

Note: You must perform an ‘End Of Day’ operation at the time you select here. If you normally perform end of day at another time, we will discuss the options with you for doing so.

Name of new owner*

Phone of new owner*

Email of new owner*

Email confirmation of this submission will be sent to this address.

Name of MBD (area manager)*

Email of MBD

Phone of MBD (area manager)*

Moneris ECR numbers

Popeyes

Restaurant ID*

Location (City)*

Requested changeover date*

The specific date that you will take ownership and begin operations.

Note: Panasonic requires a minimum of 3 business days notice to schedule and assist in your ownership change.

Once this form has been submitted you will receive a reply within 24 hours on the following business day with a reference number, along with further instructions if required.

Requested changeover time (HR + MM)*

Enter the requested time in 24 hour format in YOUR local time zone.

Note: You must perform an ‘End Of Day’ operation at the time you select here. If you normally perform end of day at another time, we will discuss the options with you for doing so.

Name of new owner*

Phone of new owner*

Email of new owner*

Email confirmation of this submission will be sent to this address.

Name of MBD (area manager)*

Email of MBD

Phone of MBD (area manager)*

Chase Merchant ID

Chase PNS (… 0300000 or 029999)

Chase Terminal ID's (101-104,112,201-205…)

Kiosk Terminal ID's (301-304…)

Fiserv (Valuelink) AKA First Data Merchant ID

ValueLink: If you provide Gift Cards through Valuelink you must ensure through them that Datawire Provisioning has been completed. Your First Data Relationship manager can assist with this. Failure to ensure provisioning may cause delays before you can begin processing cards. If you have multiple locations, the MID may be the same for all. If so, you should have unique ‘Alternate ID’s’ for each location.

HiFive Chicken

Restaurant ID*

Location (City)*

Requested changeover date*

The specific date that you will take ownership and begin operations.

Note: Panasonic requires a minimum of 3 business days notice to schedule and assist in your ownership change.

Once this form has been submitted you will receive a reply within 24 hours on the following business day with a reference number, along with further instructions if required.

Requested changeover time (HR + MM)*

Enter the requested time in 24 hour format in YOUR local time zone.

Note: You must perform an ‘End Of Day’ operation at the time you select here. If you normally perform end of day at another time, we will discuss the options with you for doing so.

Name of new owner*

Phone of new owner*

Email of new owner*

Email confirmation of this submission will be sent to this address.

Name of MBD (area manager)*

Phone of MBD (area manager)*

Email of MBD

Moneris ECR numbers

Kiosk Terminal ID's (301-304…)

Chaiiwala

Restaurant ID*

Location (City)*

Requested changeover date*

The specific date that you will take ownership and begin operations.

Note: Panasonic requires a minimum of 3 business days notice to schedule and assist in your ownership change.

Once this form has been submitted you will receive a reply within 24 hours on the following business day with a reference number, along with further instructions if required.

Requested changeover time (HR + MM)*

Enter the requested time in 24 hour format in YOUR local time zone.

Note: You must perform an ‘End Of Day’ operation at the time you select here. If you normally perform end of day at another time, we will discuss the options with you for doing so.

Name of new owner*

Phone of new owner*

Email of new owner*

Email confirmation of this submission will be sent to this address.

Name of MBD (area manager)*

Email of MBD

Phone of MBD (area manager)*

Payment Provider

Chase Merchant ID

Chase PNS (… 0300000 or 029999)

Chase Terminal ID's (101-104,112,201-205…)

Moneris ECR Numbers

Kiosk Terminal ID's (301-304…)

Tim Hortons

Restaurant ID*

Location (City)*

Requested changeover date*

The specific date that you will take ownership and begin operations.

Note: Panasonic requires a minimum of 3 business days notice to schedule and assist in your ownership change.

Once this form has been submitted you will receive a reply within 24 hours on the following business day with a reference number, along with further instructions if required.

Requested changeover time (HR + MM)*

Enter the requested time in 24 hour format in YOUR local time zone.

Note: You must perform an ‘End Of Day’ operation at the time you select here. If you normally perform end of day at another time, we will discuss the options with you for doing so.

Name of new owner*

Phone of new owner*

Email of new owner*

Email confirmation of this submission will be sent to this address.

Name of MBD (area manager)*

Email of MBD

Phone of MBD (area manager)*

Chase Merchant ID

Chase PNS (… 0300000 or 029999)

Kiosk Terminal ID's (301-304…)

Chase Terminal ID's (101-104,112,201-205…)

Fiserv (Valuelink) AKA First Data Merchant ID

Church's Chicken

Restaurant ID number*

Location (City)*

Requested changeover date*

The specific date that you will take ownership and begin operations.

Note: Panasonic requires a minimum of 3 business days notice to schedule and assist in your ownership change.

Once this form has been submitted you will receive a reply within 24 hours on the following business day with a reference number, along with further instructions if required.

Requested changeover time (enter hours AND minutes)*

Enter the requested time in 24 hour format in YOUR local time zone.

Note: You must perform an ‘End Of Day’ operation at the time you select here. If you normally perform end of day at another time, we will discuss the options with you for doing so.

Name of new owner*

Phone of new owner*

Email of new owner*

Payment Processor*

Moneris ECR numbers

TD Merchant ID number

TD Pinpad ECR numbers

GIVEX Merchant ID

Dairy Queen

Restaurant ID number*

Location (City)*

Requested changeover date*

The specific date that you will take ownership and begin operations.

Note: Panasonic requires a minimum of 3 business days notice to schedule and assist in your ownership change.

Once this form has been submitted you will receive a reply within 24 hours on the following business day with a reference number, along with further instructions if required.

Requested changeover time (enter hours AND minutes)*

Enter the requested time in 24 hour format in YOUR local time zone.

Note: You must perform an ‘End Of Day’ operation at the time you select here. If you normally perform end of day at another time, we will discuss the options with you for doing so.

Name of new owner*

Email of new owner*

Phone of new owner*

TD Merchant ID number

TD Pinpad ECR numbers

Fiserv (Valuelink) AKA First Data Merchant ID

Tax #

Mary Browns

Restaurant ID number*

Location (City)*

Requested changeover date*

The specific date that you will take ownership and begin operations.

Note: Panasonic requires a minimum of 3 business days notice to schedule and assist in your ownership change.

Once this form has been submitted you will receive a reply within 24 hours on the following business day with a reference number, along with further instructions if required.

Requested changeover time (enter hours AND minutes)*

Enter the requested time in 12 hour format in YOUR local time zone.

Note: You must perform an ‘End Of Day’ operation at the time you select here. If you normally perform end of day at another time, we will discuss the options with you for doing so.

Name of new owner*

Email of new owner*

Phone of new owner*

Name of MBD (area manager)*

Email of MBD

Phone of MBD (area manager)*

Moneris ECR numbers

EnterPIN pad serial numbers (separate with comma)

PIN Pad serial numbers

GIVEX Merchant ID

Tax #

HST / Tax ID

Additional Comments

Please use this space to add any additional information that you feel we should know.

Agreement to billing*

** The standard fee of $375 will be charged for the ownership change. This includes MEV-WEB configuration and conversion.

The new owner is responsible for submitting the required information to Panasonic no later than ten business days prior to the changeover or Panasonic will be forced to postpone or cancel the project.

By submitting this form, the new owner acknowledges and agrees to pay the associated costs per location, per ownership change. Should the account change be cancelled, postponed or delayed, we require 24 hours notice or a cancellation fee of $275 will be applied. The Submit button will appear when the ‘I agree’ box above has been checked.

I Agree

Agreement to billing*

** The standard fee of $275 will be charged for the ownership change. By submitting this form, the new owner acknowledges and agrees to pay the appropriate configuration and administration fee per location, per ownership change. Should the account change be cancelled, postponed or delayed, we require 24 hours notice or there will be a $275 cancellation fee applied. The Submit button will appear when the ‘I agree’ box above has been checked.

I agree

* Please note that Panasonic requires a minimum of three (3) business days to process and schedule change of ownership requests *

** Should your account change need to occur outside the hours of 8am to 4pm EST – Monday thru Friday, additional resources will be required and the change of ownership fee doubled due to OT rates **

If you can not complete all the required fields on this form, please contact our help desk at 800-463-7655 for assistance.

Name

This field is for validation purposes and should be left unchanged.