Site Survey Form Survey Date: Client Information Company Name: Site Information Estimate Installation Date: Your Current POS PetrotechPOS Verifone Ruby CI Commander Gilbarco Passport Verifone Ruby Topaz Commander Other *To find out the version of the commander: 1 - Go to CSR Menu (bottom right corner) 2 - Select option 5 3 - Login with the manager ID and Password 4 - Click "Help" & then "About", the version will be shown under Configuration Forecourt Type Wayne Fusion Verifone Commander Gilbarco Passport Other Network FD Buypass Heartland Other Debit Encryption Key: Wayne —Please choose an option—Vista IIVista IIIovation-Iovation-II-HelixHarmony Gilbarco —Please choose an option—Encore 300Encore 500Encore 500s/700sAdvantage Tokheim —Please choose an option—Premier BPremier C262A Bennett How Many Dispensers (MPD): —Please choose an option—123456789101112 How Many Pumps/Fueling Positions: —Please choose an option—123456789101112131415161718192021222324 No Of Tanks: —Please choose an option—1234567891011121314151617181920 Grades: Tank Size: Dispenser Pictures Please provide dispenser pictures: one of the Outside of dispenser door (include card reader) and one of the Inside of dispenser door Full Pump Picture: (Taken From Aleast 10 Feet Away ) Inside Of Dispenser Door: Outside Of Dispenser Door: Types Of POS(Ruby etc): Fuel Controller Box: Fuel Setup Area(D-Box,G-Box etc): Internet Setup(Cyberia, MAACO etc): (Optional) Current Credit Card Processing Statement: