Reseller/Agent Order Submission Form Please enable JavaScript in your browser to complete this form.Agent InformationName *Email *Phone *Store InfoStore Name *Store Type *LiquorTobaccoConvenienceGrocerySuper MarketContact Person *Email *Phone *AddressAddress Line 1Address Line 2CityStateZipCountryUSAShippng address if it is different than store addressAddress Line 1Address Line 2City StateZipCountryUSAWith/Without HardwareWith HardwareWithout HardwareCurrent POSHas current POS (If you already using any POS system, we will try to migrate your inventory data into new JMSC POS system)Paying byCharge to AgentCharge to Store OwnerAdditional ServicesDesktop Support (Mandatory)Mobile AppScan Data ReportingJMSC Cloud BackupPurchase OrderDeal-Penny ProgramScan POOnline Data IntegrationCommentsShipmentGround ShipmentOvernight Shipment (May charge extra depending on location, courier service)If select overnight, then we need to call and confirm if they are okay with charges Submit