Credit Info Our agent directed you to this form as our records indicate that you do not have either a help desk contract for phone support, or require credit card approval for an on-site service call. Please do not enter any Credit Card information into this form. This is simply an Approval confirming that you agreed to the billing rates advised, and that we will contact you on the next business day to gather your credit card information. Help Desk Telephone Support is billable at $110 per incident, and On-site Service Calls are billable at $110/hr for labor and $95/hr for travel (both ways), plus parts used. After hours On-site Service calls are billable at $220/hr for labor and $190/hr for travel (both ways) plus parts used. To avoid these fees, please contact our admin department at 1-800-657-9436 ext 2253 to discuss additional support options for your restaurant. After submitting this form a member of our credit team will contact you during our standard business hours (M-F 9-5 EST) to secure to secure payment and/or discuss your future support/service needs. Please have your credit or debit card ready.Name of Person Authorizing Credit Card to be billed* Contact Phone Number* Contact Email* Name of franchisee / Nom de franchisee* Name of Franchise* Restaurant ID #* Confirm*Please indicate below which option applies. This confirms you have have been advised and approve billing at the rate and amount indicated above, as agreed during your call with the help desk. HD Support On-Site Call Estimated Amount Quoted*By submitting this form I, the submitter, agree to billing and give Panasonic the authority to hold any applicable charges, and that the location is in compliance with the requirements listed above.