Questionnaire

Adding Terminal to ATM Portfolio Questionnaire

The following questionnaire will provide the most expeditious method of completing the required ATM paperwork necessary to add an ATM to your existing ATM portfolio. Once the questionnaire is completed your answers will automatically generate the completed paperwork required. You MUST answer all of the questions or you may experience delays in paperwork processing.

Note: due to the processing admin time required to setup all new terminals a one-time $35.00 setup fee will be deducted from your ATM cash replenishment account.

ATM Owner Info

Name of ATM owner or individual requesting qualification for setup in ATM banking network.

First Name

Last Name

Social Security Number (xxx-xx-xxxx)

ATM Owner Date of Birth (mm/dd/yyyy)

ATM Owners Home Street Address

Owner Home City

Owner Home State

Owner Zip Code

Owner Email Address

Owner Phone or Mobile # (xxx-xxx-xxxx)

ATM Terminal Info
In this section, enter info only when it is different from your original portfolio info.

The ATM has online monitoring capability. What email address should we send the login and password information to?

What ATM monitoring web portal log on username would you like?

Fraud Claims: In the event a customer files a claim for not receiving appropriate funds during a transaction, you will receive a claim notification via email. What email address would you like to receive these claims(if same as above leave blank)?

ATM itself requires a six digit pin number to access ATM operator menus. What is your six digit number preference?

ATM has capability of sending email and SMS text message alerts when there is an error at the ATM, or the ATM reaches a "low cash" threshold. What email address would you like to receive these alerts (if same as above leave blank, if you don't want email alerts write "no")?

For SMS text msg alerts, please provide a phone number and service provider. If you do not want text msg alerts, leave blank.

Phone Number (xxx-xxx-xxxx)

Service Provider

What low cash dollar amount do you want to be alerted for (Example $500; when the ATM goes below $500 you will be alerted):

ATM Location Info

Name of store/location where the ATM will be located.

Property Type

ATM Location Street Address

ATM Location City

ATM Location State

ATM Location Zip Code