Site Survey Form

    Survey Date:


    Client Information


    Company Name:


    Site Information


    Estimate Installation Date:


    Your Current POS

    *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


    Network

    Debit Encryption Key:


    How Many Dispensers (MPD):

    How Many Pumps/Fueling Positions:


    No Of Tanks:


    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: