IBM RETAIL APPLICATION SERIAL NUMBER REQUEST FORM
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DATE: _____________           CHECK ONE:   NEW ___  CHANGE ___

IBM ORDER NUMBER: __________  PMR NUMBER (If applicable): ________

REQUESTOR NAME: _____________________________ (Company Name)

IBM CUSTOMER NUMBER: ____________ (7 digit alphamumeric)

SUB-CUSTOMER NUMBER: ____________ (1-12 digit alphanumeric)
    (N/A for IBM Direct Customers)
    (Required for Business Partners - UNIQUE ID for BP END USERS)

GEOGRAPHY (Required): __ (US, AP, CA, LA, EM)

FEATURES (Check one or more):

NO FEATURES            ___        INSTALLATION CONFIG.   ___
CREDIT AUTHORIZATION   ___        INVENTORY MANAGEMENT   ___
TIME AND ATTENDANCE    ___        NIGHT OPERATOR         ___
ELECTRONIC MAIL        ___        PROMOTIONAL EVENTS     ___
STORE CALENDAR         ___        LABOR SCHEDULING       ___

STORE NUMBER   STORE NAME                NUMBER OF    SERIAL NUMBER
(5 digits)     (20 characters max)       REGISTERS

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CALLER NAME: _______________________________________________________

PHONE NUMBER: ______________________________________________________

INTERNET ID: _______________________________________________________
    (or internal IBM VM ID)

FAX NUMBER: ________________________________________________________