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Please answer the questions listed below:

First Name
Last Name
Company
Best way to contact:
Email
Phone
Country
     
Are you currently a Pin Distributor for a carrier?
Does your Carrier currently generate Pins to be printed on the scratch card?
How many different products carrier do you carry?
How many denominations for each product do you have?
(eg. 5, 10, 20, 50, 100)
How soon are you thinking about rolling out this new product?
How many machines will you purchase on your first order?
How many countertop machines?
How many Self-service Kiosk?
How many Jade Box M?
Our machines connects to our servers using internet    
Does all you intended retailers have internet connection?
Does your carrier have GPRS or DOS (Data Only Sims) available in your area of deployment?
Are VeriFone terminals available in your country?
Do you have a freight forwarder in the USA that will deliver the terminals to your country?
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