Free ATM Machine Placement Request Form : Green Genie ATM

ATM Placement Form


Type of ATM service requested:	Free Atm placement	50/50 Partnership
Your Email Address:
Your First Name:
Your Last Name:
Business Name:
Street Address:
City:
State
Zip:
Phone:
Type Of Location:		If "other" please specify:
Is Alcohol Served?:
Years In Business:
Average Daily Visitors:
Hours Of Operation:
What "non cash" forms of payment do you accept?	Credit Cards	Checks	Other
Do you currently have any ATM Machines Installed at Your Location?
Additional Information: