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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  
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: