Company:   Last Name:   First Name:   Country: -- Select -- AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntiguaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBritish Virgin IslandsBruneiBulgariaBurkina FasoBurmaBurundiCambodiaCameroonCanadaCape VerdeCentral African RepublicChadChileChinaColombiaComorosCongoCongoCongo (Zaire)Cook IslandsCosta RicaCote d'Ivoire (Ivory Coast)Cote d'Ivoire)CroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFederated States of MicronesiaFijiFinlandFranceFrench GuianaFrench PolynesiaGabonGaza Strip and West BankGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMoldovaMonacoMongoliaMontserratMoroccoMozambiqueNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarReunionRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbia and MontenegroSerbia and Montenegro (Yugoslavia)SeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth KoreaSpainSri LankaSudanSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandThe GambiaThe Holy SeeTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUnited States Virgin IslandsUruguayUzbekistanVanuatuVenezuelaVietnamWest Bank and Gaza StripWestern SaharaYemenZambiaZimbabwe   How many stores do you have?:   How many games do you operate?:   Please advise number of games you want to convert in each of your present centers and numbers you expect to convert in the next 12 months:             Actual In the next 12 months   Also please advise if you operate rides that can use our Playcard driven motorized turnstile. (like bumper cars, roller costers, carrousels, etc) Yes No   Do you operate with coins or tokens?: coins tokens   How much  do you charge your customers to play a game like Daytona twin?:   What is the current price of operation of the latest Sega Simulation?:   How many pieces are required to start the above mentioned example Sega game?:   Do you have any competitors using any other debit card system in your market?: Yes No   E-mail:   Telephone/Fax number:

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