CFNnet Product Order Form

(All below information must be completed before an order can be processed.)

Participant Number and Name: ______________________________________________________________________

CFN Site Number:  _______________________________________________________________________________

Site Name:______________________________________________________________________________________

Site Address: ____________________________________________________________________________________

City/State/Zip:___________________________________________________________________________________

Tranz Machine Phone Number: ______________________________________________________________________

Site Phone Number and Contact: ____________________________________________________________________

Shipping Address:  ________________________________________________________________________________

City/State/Zip:___________________________________________________________________________________

Please specify shipping:    Ground: _____  Next Day: _____2^nd Day: _____3^rd Day: _____

Time Zone (Eastern, Central, Mountain, Pacific):

Daylight Savings: Yes: ________ No: _____

Equipment needed:  (please specify quantity)

           R-Tranz 380/Pin Pad 1000/Printer 900*                 (Package Price = $332.00)

           Download Application Only                                  (TBD)

_____ Cable to Ruby (380___)                                        ($35.00)

           (Ruby Cable also for Sapphire)

_____ Cable for G-Site (380___) and adapter                    ($35.00)

           (G-Site cable also for Passport and Wayne Nucleus)

_____ Replacement Cable to Printer from Tranz 380          ($10.00)

_____ Replacement Cable to Pin Pad from Tranz 380         ($10.00)

_____ Pin Pad 1000                                                        ($114.00)

_____ R- Printer 900*                                                    ($99.00)

_____ R-Tranz 380*                                                       ($109.00)

*Refurbished

The package price includes all cables and one download.  It DOES NOT include any expedite charges or shipping costs.  All equipment is under 1 year warranty, some restrictions might apply at the discretion of the Vendors and Manufacturers..  Orders will be processed in the order they are received.  Generally, orders will be shipped 7-10 business days from the date the order is received.  Hardware returned is subject to a 20% restocking fee.  Returns must be unused and in original packaging. Prices subject to change without notice.

Equipment will be shipped when site is approved and billed separately.

A fee of $500.00 for the registration of a CFNnet site must be submitted with site registration. 

Signature:____________________________________________       Date: ___________________

FAX COMPLETED FORM TO CFN FAX:  650-356-3050