NRSPLUS - NRS Petro Survey

Section

Sales Channel Information

Are you a Sales Person?*

Yes

No

Full Name

Email

Phone

RSM

Gas Station Information

Gas Station Name*

Owner Name*

Gas Stations Address*

Gas Station City*

Gas Station State

Gas Station ZipCode*

Owner Phone*

Owner Email*

Is the site an unbranded/independent gas station?*

Yes

No

Not Sure

If Branded, does the contract with the brand allow them to switch Credit Card processing and use external vendors

Yes

No

Not Sure

Is the gas station attached to a convenience store/mini-mart/bodega?*

Yes

No

Other

What is the Credit Card processing company?*

What is the current POS (Point of Sale) system*

Are you a current Boss Revolution Retailer with NRS?*

Yes

No

Not Sure

Boss Revolution Number

What is the model of the Gas Dispensers?*

How many Gas Dispensers are there? (1 dispenser usually has two fueling points, one on each side)*

Who is the manufacturer of the Forecourt Controller and model?(The forecourt controller is the device that turns the pumps on/off)*

Is the Forecourt Controller inside or outside of the convenience store?*

Inside

Outside

What company is actively servicing your gas station?*

Company Phone*

Primary point of contact*

What is the closing time of the gas dispensers?*

Do the gas dispensers power down at the end of the day?*

Yes

No

HOW DID YOU HEAR ABOUT NRS PETRO?*

Gas Dispenser and POS Photos

Picture of Gas Dispenser*

Picture of Point of Sale (POS) system*

Picture of Forecourt Controller*