Terminal Order Form

We're happy to include up to two smart terminals for all accounts at no cost. If you need additional terminals, please complete your order below.

"*" indicates required fields

Step 1 of 3

Practice Information

This field is hidden when viewing the form

Start Date

Merchant ID*

You can find your merchant ID in your Poynt account portal.

Practice Name*

Contact Name*

First Last

Contact Email*

Contact Phone*

Choose your Terminals

There are two varieties of terminals to choose from.

Please Note: To ensure we can support your hardware for the life of the account, we do not allow purchasing terminals.

GoDaddy Smart Terminal

Your practice deserves modern technology. The Poynt GoDaddy Smart Terminal is an all-in-one smart device you’ll actually want to have on your counter.

Monthly Rental: $35.00

GoDaddy Smart Terminal Flex

Everything the bigger one can do, but in a smaller package.

Monthly Rental: $25.00

Shipping Address*

Please let us know where you'd like your terminal(s) shipped to.

Street Address Address Line 2 City State ZIP Code

Billing Information

Same as Shipping Address?

Yes

Billing Address*

Street Address Address Line 2 City State ZIP Code

Credit Card*

American Express

Discover

MasterCard

Visa

Card Number

Expiration Date

Security Code Cardholder Name

Terminal Rental Agreement

This agreement is made on 04/25/2025 between Moolah and .

Rental Equipment: The rental equipment shall include a credit card terminal, power cord, and any necessary accessories. The rental equipment shall be delivered to , .

Rent: The rent for your equipment shall be , payable on a monthly basis. The first payment will be processed on 04/29/2025.

Use of Rental Equipment: shall use the rental equipment only for the purpose of processing credit card transactions. The customer shall not modify, repair or tamper with the rental equipment.

Damage to Rental Equipment: shall be responsible for any damage to the rental equipment during the rental term, except for normal wear and tear.

Loss or Damage: shall be responsible for the loss or damage of the rental equipment during the rental term. If the rental equipment is lost or damaged beyond repair, shall be responsible for the replacement cost of the rental equipment.

Return of Rental Equipment: shall return the rental equipment in good condition upon cancellation of the merchant account or termination of this agreement. If the rental equipment is not returned within 30 days of cancellation or is returned in damaged condition, shall be responsible for the cost of repairs or replacement.

Indemnification: shall indemnify and hold harmless Moolah from any liability, damages or claims arising out of the use of the rental equipment.

Governing Law: This agreement shall be governed by and construed in accordance with the laws of California.

Entire Agreement: This agreement contains the entire understanding between the parties and supersedes all prior negotiations, representations or agreements, whether written or oral.

Modification: This agreement may not be modified or amended except in writing signed by both parties.

Binding Effect: This agreement shall be binding upon and inure to the benefit of the parties hereto and their respective successors and assigns.

Monthly Rental Total

Your card will be charged every month until your merchant account is cancelled and/or hardware is returned. Your first payment will process on 04/29/2025.

Order Number

This field is hidden when viewing the form

Description

Need Assistence?

If you need assistence with your terminal order, please contact us via email or call us at the number below.

800-625-1670

Phone Support
Monday-Friday 9:00am to 5:00pm PST

Email Support
Monday-Friday 6:00am to 5:00pm PST