ReChek - Merchant Maintenance

We really appreciate your help. Enjoy your free gift. Please note that you must have the "Auto-number" from the email or letter that we sent you for this form to work. The information will be sent to us when you hit "Submit" button below.
Please fill in these first 4 fields.
Store Manager: (required)
Email Address: (required)
Auto-number: (required)
Are you sending in corrections? (required)	Yes No
Then, fill in only the fields that need to be corrected.
Company
Your Company's legal name:
Doing business as:
Contact
Website:
Physical Address
Street:
Street 2:
City, State, Zip:
County:
Mailing Address
Street:
Street 2:
City, State, Zip:
County:
Phone Numbers
Business Phone:
Business Fax:
Mobile Phone:
Do you have any questions or comments about our services?
Would you like us to call you?	Yes No
Do you need new stickers for your registers and doors?	Yes No