New Customer or Store Transfer Form General InformationTransfer/Open DateTransfer/OpenName *Email Address *PhoneStore AddressCityState/ProvinceStore # (If applicable)Additional Contacts?YesNoAdditional Contacts?Are there any additional contacts for this store?Name *PhoneEmail Address *Existing Customer?YesNoDoes the customer have an existing parent ID?Parent ID (Customer Code)List the Customer code of the Parent ID for linking within our system.LLC/Billing InformationLLC / INC Name *CityState/ProvinceEIN0 / 100Is this a new location or an existing Costley affiliated locationNewExistingPlease list all services currently offered by CEDMBsArcadeNetwork ManagementJukeboxAudioVOIPCamerasDigital SignageNew Services to be provided from CostleyPlease include any potentional services that may need to be quoted.ServicesDMBsArcadeNetwork ManagementJukeboxAudioVOIPCamerasDigital SignageService InformationAdditional CommentsFile UploadDrag and Drop (or) Choose FilesPlease provide picture of print, gameroom, or relevant photosConsent *Please give your consent for us to use the provided data in accordance with our privacy policy.SubmitSave as DraftPlease do not fill in this field.
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