RESTAURANT ACCOUNT CHANGE (OR CHANGE OF OWNERSHIP) 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. To schedule, configure and administer the necessary changes required for the change of ownership, a fee of $275 will apply. Franchise*Please choose your franchiseChaiiwalaChurch's ChickenDairy QueenHiFive ChickenMary BrownsPopeyesTim HortonsWilliamsQuebec*Locations in Quebec require additional information. This location is in the province of QC This location is NOT in QC PopeyesRestaurant ID* Location (City)* Requested changeover date* MM slash DD slash YYYY 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. : HH MM 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.Chase Merchant ID Chase PNS (… 0300000 or 029999) Chase Terminal ID's (101-104,112,201-205…) Kiosk Terminal ID's (301-304…) SRM file number SRM ID number SRM access code SRM Outgoing Access Code TPS Number TVQ Number HiFive ChickenRestaurant ID* Location (City)* Requested changeover date* MM slash DD slash YYYY 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. : HH MM 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 Chase Merchant ID Chase PNS (… 0300000 or 029999) Chase Terminal ID's (101-104,112,201-205…) Kiosk Terminal ID's (301-304…) ChaiiwalaRestaurant ID* Location (City)* Requested changeover date* MM slash DD slash YYYY 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. : HH MM 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…) Tim Hortons QCRestaurant ID* Location (City)* Requested changeover date* MM slash DD slash YYYY 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. : HH MM 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…) First Data (Timcard) 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.SRM file number SRM ID number SRM restaurant number SRM access code SRM Outgoing Access Code TPS Number TVQ Number WilliamsRestaurant ID number* Location (City)* Requested changeover date* MM slash DD slash YYYY 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. : HH MM 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*Global Payment Merchant ID Global Payment ECR Number(s) Ackroo ID for each terminal (Williams Points Card) Church's ChickenRestaurant ID number* Location (City)* Requested changeover date* MM slash DD slash YYYY 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. : HH MM 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*A selection from this list is requiredMonerisTDMoneris ECR numbers TD Merchant ID number TD Pinpad ECR numbers Dairy QueenRestaurant ID number* Location (City)* Requested changeover date* MM slash DD slash YYYY 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. : HH MM 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 First Data (DQ Loyalty Card) Merchant ID Tax # Mary BrownsRestaurant ID number* Location (City)* Requested changeover date* MM slash DD slash YYYY 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. : HH MM 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*Chase Merchant ID number Terminal Number Chase PNS Tax # GIVEX Merchant ID HST / Tax ID Additional CommentsPlease use this space to add any additional information that you feel we should know.Agreement to billing*** A billable work order (which includes on site labour and travel) will be required as a tech is needed to manually program the SRM with the info you are submitting with this form. 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 will be applied. The Submit button will appear when the ‘I agree’ box above has been checked. I Agree Agreement to billing ($275 during business hours, $550 outside those hours)*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. Δ