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Kiosk Portal
Request Your Account
Account Type
Subscription
Revenue Share
Demo
Reseller Information
The reseller is the Xerox partner or entity through which the Workplace kiosk agreement was made.
Reseller Name (Required)
This field is required.
The Kiosk Owner cannot be the same as the Reseller.
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Street Address
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Country (Required)
Select Country
Finland
France
Germany
Ireland
Italy
Netherlands
Slovakia
Spain
United Kingdom
United States
Demo
This field is required.
State
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City
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Zip Code
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Kiosk Owner Company Information
The Kiosk Owner is the commercial entity that owns the kiosk and receives the kiosk transactional revenue.
Company Name (Required)
This field is required.
Enter valid inputs!
Street Address
Enter valid inputs!
Country (Required)
Select Country
Finland
France
Germany
Ireland
Italy
Netherlands
Slovakia
Spain
United Kingdom
United States
Demo
This field is required.
Enter valid inputs!
State
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City
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Zip Code
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Kiosk Information
Kiosk Serial Number (Required)
This field is required.
Enter valid inputs!
Same mailing address as Kiosk Owner Company
Street Address
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Country (Required)
Select Country
Finland
France
Germany
Ireland
Italy
Netherlands
Slovakia
Spain
United Kingdom
United States
Demo
This field is required.
State
This field is required.
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City
This field is required.
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Zip Code
This field is required.
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Add Another Kiosk
Additional Kiosks
Add Kiosk
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OK
Kiosk Administrator Information
First Name (Required)
This field is required.
Enter valid inputs!
Last Name (Required)
This field is required.
Enter valid inputs!
Email Address
(Required)
This field is required.
Enter valid inputs!
Business Address (Required)
This field is required.
Enter valid inputs!
Country (Required)
Select Country
Finland
France
Germany
Ireland
Italy
Netherlands
Slovakia
Spain
United Kingdom
United States
Demo
This field is required.
Enter valid inputs!
State
(Required)
This field is required.
Enter valid inputs!
City (Required)
This field is required.
Enter valid inputs!
Zip Code (Required)
This field is required.
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Add Another Administrator
Additional Administrators
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Add Kiosk Administrator
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OK
Host Company Information
The host is the commercial entity that will host the kiosk and receive a share of kiosk transactional revenue.
Company Name (Required)
This field is required.
Enter valid inputs!
Company Email Domain
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Street Address
Enter valid inputs!
Country (Required)
Select Country
Finland
France
Germany
Ireland
Italy
Netherlands
Slovakia
Spain
United Kingdom
United States
Demo
This is a required field.
State
Enter valid inputs!
City
Enter valid inputs!
Zip Code
Enter valid inputs!
Host Administrator Information
First Name (Required)
Enter valid inputs!
This field is required.
Last Name (Required)
Enter valid inputs!
This field is required.
Email Address
(Required)
This field is required.
Enter valid inputs!
Same mailing address as Host Company
Street Address
Enter valid inputs!
Country (Required)
Select Country
Finland
France
Germany
Ireland
Italy
Netherlands
Slovakia
Spain
United Kingdom
United States
Demo
This field is required.
Enter valid inputs!
State
Enter valid inputs!
City
Enter valid inputs!
Zip Code
Enter valid inputs!
Add Another Administrator
Additional Administrators
Add Host Administrator
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OK
Revenue Share Settings
Revenue Share Percentage
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
Allow the host to issue refunds.
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Reseller
Kiosk Owner Company
Kiosk
Kiosk Administrators
Host Company
Host Administrators
Revenue Share Settings
Revenue Share Percentage:
Host refunds:
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Cancel Account Request
This will close the account request page and return you to the login page. Your entries will not be saved.
