Form

Store Number*

Please enter your 5-digit Zaxby's store number

Franchise Owner's First Name*

Franchise Owner's Last Name*

Federal Tax ID*

Franchise Business Billing Name*

Bill To Address*

Bill To City*

Bill To State*

Bill To Zip Code*

Business Phone*

Email*

Accounts Payable Contact Name

Accounts Payable Contact Email

Please complete this section for specific store information.

Store Address*

Store City*

Store State*

Store Zip Code*

Please complete this section for the Primary Contact. This is where communications & contracts will be sent.

Contact First Name*

Contact Last Name*

Phone number*

Contract Recipient Email*

Hardware Package

Store Options*

Would you like to purchase an additional tablet?*

Yes

How many registers do you plan to hang?

Do you plan on reusing your Bixolon printers?

Comments

If you would like to purchase any additional hardware, please list it below.