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Bingo Supplies, Pull-Tabs & Gaming Equipment
Name
Company Name
*
0 / 75
Street Address
*
Apartment, suite, etc
City
*
State/Province
*
ZIP / Postal Code
*
Email Address
*
Phone
*
Gaming License # (GR #)
Expiration Date of Gaming License
Establishment TID Number
What types of Games do you currently use or are interested in using?
3 Window $1.00 $599 Top Prize
3 Window $1.00 $500 Top Prize
3 Window $1.00 $300 Top Prize
3 Window $1.00 $250 Top Prize
3 Window $0.50 $250 Top Prize
3 Window $0.25 $150 Top Prize
3W $1 "Criss Cross Style"
3W $0.50 "Criss Cross Style"
Other
What is your preferred method of Payment?
*
Cash
Check
E-Check
Credit Card
Are you interested in a new Nevada Gold II Pull Tab Dispenser?
*
Yes
No
Do you have a website for your Establishment?
*
Yes
No
If Yes, what is the website address associated with your Establishment?
If No, are you interested in having one created for your Establishment?
*
Yes
No
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