ATM Setup Form

"*" indicates required fields

Location Name* Location Street* Location City* Location State* Location Zip Code*

Location Phone Number*

Merchant Name*

Location Email

Agent Name

Agent Phone Number

Agent Email

Total Surcharge*

Merchant Surcharge Commission*

Agent Surcharge Commission

Choose ATM Type*

ATM Serial Number

ATM Ownership*

Choose Amount Dispensed

Choose Denomination

Choose Communication Type*

Wireless Serial Number (if being used)

Notes for Setup

Upload File

Max. file size: 100 MB.

Phone

This field is for validation purposes and should be left unchanged.