Free Placement Form

This form is for the free placement of the Valor VL100 and the Dejavoo QD4.
Merchant & Partner Information
A signature request will be sent to this email.
A confirmation email will be sent to this email.
PIN Pad:

The Valor VL300 and Dejavoo QD3 PIN Pads require a $7.95 debit gateway fee.

Download Parameters
Application Type:
Debit Enabled:
PIN Pad:
Touchscreen Signature Capture:
Primary Connection Method:
Backup Connection Method:
Dual Pricing Configuration
% above cash price (1-5%)
Flat fee amount
Minimum amount to default to flat fee
Discount Frequency:
Ship To
Shipping Address
Zip Code
Bill to:
All set!

Your submission has been received and our deployment team will get to work as soon as possible.

You should receive an email confirmation with an attached PDF of this form with the info you provided.

Your merchant should receive a digital signature request at the email you provided.
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