Order Request Form

Please complete the order request form below. Someone from our sales team will contact you by phone/e-mail very shortly to discuss your requirements:

123 HIRE CUSTOMERS PLEASE NOTE:

If you have previously short term hired from 123 Hire and simply require an order form, please click here. N.B. Please ensure your e-mail message includes your merchant number, company name, telephone number, mobile network choice (if any), the number of terminals and accessories you require and the dates you require them. We will then e-mail you the relevant order form for completion. **Minimum 7 days notice required**. Orders placed within 7 days are subject to availability and acquirer timescales.

For all other enquiries please complete the order request page in full.

Company Details

Company Name

Required

Trading Name (if different)

Trading Address

Required

Post Code

Required

Country (UK ONLY)

What is the type of business ownership?

What type of goods or services do you provide?

Required

Length of trading

Required

Years	*
Months	*

Contact Title

Required

Name

Required

First	*
Surname	*

e-mail

Required

Position

Main Contact Tel Number

Required

Mobile Number (If different)

What would be a convenient time to contact you?

Questions Relating to Mobile Terminal

Number of terminals required?

Are you interested in: * Required Short Term Hire
Long Term Hire
Purchase

Questions Relating to Card Payments

Do you currently accept cards? * Required Yes No

If yes, with who?

What are you charged for processing credit cards? %

What are you charged for processing debit cards? Pence per transaction

Do you/will you want to accept 'customer not present' transactions? Yes No

Other Information

How did you hear about 123?

Required

Are you a member of a trade association or buying group? *

Required

Yes No

If so, which one?

Please let us know if you have any further questions or queries.

Please enter the characters below exactly as they appear. This is case sensitive. This lets us know you are human and not a spammer.