Certified Reseller: Douglas LaMar Ph: 402-884-4320 - Call Today! Fx: 866-562-4877 Cell: 402-212-4284 Email: dlamar@lamarsoft.com Please submit the form below for pricing and product information. Also please feel free to contact me with any questions. 1. Company & Contact Information: Fields marked with a star are required. Company Name: Required First Name: Required Last Name: Required Title: Address Required City Required State/Province: -- Select -- Alabama Alaska Arizona Arkansas California Colorado Connecticut D.C. Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Required Zip/Postal Code: Required Telephone Number: Ext Required Fax Number: Cell Number: Ext E-mail Address: Required 2. Additional Information: PayJunciton does not sell user or subscriber information to third-party marketing companies. Types of Good/Services Sold Required Estimated Monthly Credit Card Sales Required How did you find us? Ex: Reseller name, Google Promo Code Do You Currently Process? Yes No Required  What Will You Do More? Swipe Cards Type them In Required Questions / Comments: