COO draft test page – Panasonic POS Client Portal

Change of Ownership EN WEB-SRM

"*" indicates required fields

Test page for development of the WEB-SRM change of ownership form.

Franchise*

Quebec*

This location is NOT in Québec

This location is in the province of Québec

Four 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. Confirmation of receipt printer compatibility
3. Disconnection of all physical MEV units
4. Provision of location and ownership change details

This form cannot be submitted until all four 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:

Configuration du système d’enregistrement des ventes.

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 your business 5. The GST registration number of your business
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

Data Collection*

I have gathered all the information required.
I understand that I must call 1-(800)- 657-9436 to provide the information gathered above.

Please confirm you have gathered the necessary information prior to completing this form.

A change of ownership will NOT be possible without this information.

2. Receipt Printer Compatibility

Receipt printers in Québec must by law have the ability to print QR codes. Older printers do not have this ability. For details on checking printer model numbers please visit the following link:

Identification de l’imprimante

Please choose the option below which best describes your installation. (required)

Receipt Printer Compatibility*

All my printers are Epson TM88 version IV, V, VI, or VII

Not all of my printers are the models listed in the option above

Receipt printer models that are not listed above will need to be replaced.
Replacement devices, including all applicable components are available for $475 plus shipping. These printers can be self-installed by following the instructions included with the device, or by scheduling a service call with a Panasonic technician.

3. SRM / MEV Disconnection*

Please choose one of these options. (required)

I have SRM / MEV devices and require a technician onsite to remove them and connect the printer directly to the POS. I approve the work order billed at $110/hr labor and $95/hr return travel.

I have SRM / MEV devices and do NOT require a technician onsite as I will have a qualified technical person to be able to work with the helpdesk to remove them and connect the printer back to the POS.

There are no physical SRM / MEV devices at this location

The process for disconnecting an SRM can be seen at the following link:

MEV Disconnection

4. 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*

** A $275 billable work order will be required, and an additional $65 per hour to convert to WEB-SRM remotely.

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 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) and an additional $275 if cancelled within 24 hours of scheduled date*

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.