Feedback / Order Form

Please fill in the following form to inform us of which iPOS products you are interested in. Should you wish to receive a FAXback form to place an order for one of our products, please be sure to include your FAX number. iPOS Technolgies Inc.
77 Progress Ave., Suite 204
Scarborough, Ontario
Canada M1P 2Y7
(647) 298-4608
(647) 439-1513 Fax

Which products are you interested in? (You may choose more than one, if necessary).

Other:

Enter any additional information in the space provided below:

Tell us how to get in touch with you:

              Name  
  Restaurant/Store  
           Address  
              City  
        State/Prov  
       Postal Code  
           Country  
            E-mail   (important)
               Tel  
               FAX   (important)
  Please contact me as soon as possible regarding this matter.

Revised: February 06, 2003.