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ATM Placement Application Form

First Name

Last Name

Title

Address

City

State

Postal code

Phone *

Email *

Business Name *

EIN Number (Tax ID)

Type of Business

ATM Location Information

ATM will be Installed at:

ATM Location Address

ATM Location City

ATM Location State

ATM Location Zip Code

ATM Location Phone Number

Banking Information

Bank Account Name *

Name of Bank

Bank Street Address

Bank City

Bank State

Bank Zip Code

Account Number *

Verify Account Number *

Routing Number *

Account Is Used For: *

Vaulting Only

Commissions & Payments Only

Vaulting, Commissions & Payments

Type Of Account *

Checking

Savings

Surcharge Amount

Merchant Share of Surcharge

My ATM Guys Processing Fee

I agree to terms & conditions provided by the company. By providing my phone number, I agree to receive text messages from the business.

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