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ATM Customer Service Number:
877-651-2867
ATM Placement Form
Please fill out the form below and submit for free atm placement or 50/50 partnership.
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
AL
AK
AZ
AR
CA
CO
CT
DE
DC
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
Zip:
Phone:
Type Of Location:
Convenience Store
Bar/Nightclub
Gas Station/Truck Stop
Hotel/Motel
Grocery Store
Clothing Store
Restaurant
Office Area
School
Indoor Mall
Strip Mall
Bowling Alley
Casino
Bingo Hall
Hospital
Housing Complex
Other
If "other" please specify:
Is Alcohol Served?:
Yes
No
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?
Yes
No
Additional Information: