Retail Checkout Scan Registration
Please complete this form to register all scanned items and transaction details for your retail checkout.
Transaction Date and Time
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Cashier Full Name
*
First Name
Last Name
Cashier Employee ID
*
Customer Full Name (if applicable)
First Name
Last Name
Customer Email (for receipt)
example@example.com
Customer Phone Number (for receipt SMS)
Please enter a valid phone number.
Format: (000) 000-0000.
Scanned Items
*
Payment Method
*
Cash
Credit/Debit Card
Mobile Payment
Gift Card/Voucher
Other
Would you like a receipt?
*
Yes, email receipt
Yes, SMS receipt
Yes, printed receipt
No receipt needed
Comments or Special Requests
Transaction Summary (Auto-calculated)
Store Location
*
Please Select
Main Branch
Mall Outlet
Airport Kiosk
Other
Complete Registration
Should be Empty: