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	Please complete every field of the following form and fax a complete copy of your menu to 775-882-5210. Your first layout will be free and there is no obligation to purchase. You will receive your layout in 3-5 business days. if you need assistance filling out this form or have any questions once submitted, please contact our Customer Satisfaction Department at 1-800-321-8105. BEFORE IMPACT CAN PROCEED WITH YOUR FREE LAYOUT, A COMPLETE MENU MUST BE FAXED TO 775-882-5210 OR EMAILED TO INFO@EIMPACTPOS.COM AS AN ATTACHED WORD, EXCEL, OR PDF FILE. Business Name: Contact Name: Address: City, State, Zip: Phone: Fax: Email: What type of product are you interested in? Indoor Outdoor Both Graphics Is this a new purchase or for an existing system? width x height New System Replacement Parts Have you seen an example of a menu board you would like your system to resemble? State a specific source: What type of system are you considering? Magnetic Illuminated Non-Illuminated Overall space available for system (indoor only): width x height Hanging Method (Indoor Only): Wall-Mount Ceiling Hung Both Changeable Pricing: Yes No Describe your decor or color preference: Estimated Installation Date: Estimated Budget Range: How did you hear about us? Internet Search Referral Trade Show Other Name & Date of Tradeshow if applicable: Is this property part of a chain or a franchise? Chain Franchise Neither Notes and Comments: info@eimpactpos.com    |    phone: 800.321.8105    |    local: 775.882.7834    |    fax: 775.882.5210